Basic competence in intensive and critical care nursing: development and psychometric testing of a competence scale

Critical care nurses' experiences of caring challenges during post-resuscitation period: a qualitative content analysis

BACKGROUND

Patients in the post-resuscitation period experience critical conditions and require high-quality care. Identifying the challenges that critical care nurses encounter when caring for resuscitated patients is essential for improving the quality of their care.

AIM

This study aimed to identify the challenges encountered by critical care nurses in providing care during the post-resuscitation period.

METHODS

A qualitative study was conducted using semi-structured interviews. Sixteen nurses working in the intensive care units of three teaching hospitals were selected through purposive sampling. The Data collected were analyzed using qualitative content analysis.

RESULTS

Participants experienced individual, interpersonal, and organizational challenges when providing post-resuscitation care. The most significant challenges include inadequate clinical knowledge and experience, poor management and communication skills, lack of support from nurse managers, role ambiguity, risk of violence, and inappropriate attitudes of physicians towards nurses' roles. Additionally, nurses expressed a negative attitude towards resuscitated patients.

CONCLUSION

Critical care nurses face several challenges in providing care for resuscitated patients. To enhance the quality of post-resuscitation care, address the challenges effectively and improve long-time survival it is crucial to implement interventions such as In-service education, post-resuscitation briefing, promotion of interprofessional collaboration among healthcare teams, providing sufficient human resources, clarifying nurses' roles in the post-resuscitation period and increasing support from nursing managers.

The competence of neonatal intensive care nurses: A systematic review

OBJECTIVE

The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings.

DESIGN

Systematic review.

DATA SOURCES

A total of eight databases, including PubMed, Scopus, CINAHL, MEDLINE, Mednar, Web of Science, ProQuest and Medic, were screened for relevant literature during February and September 2022.

REVIEW METHODS

The systematic review process followed Joanna Briggs Institute guidelines. The inclusion criteria were: 1) (P = population) registered nurses; 2) (C = concept) the competence; 3) (C = context) nursing in neonatal intensive care units; and 4) cross-sectional study as study method. A critical appraisal tool for cross-sectional studies from Joanna Briggs Institute was used by two independent reviewers. After data extraction, thematic analysis was performed.

RESULTS

The database searches yielded a total of 8887 studies and after two independent evaluations, a total of 50 eligible studies were identified comprising of 7536 registered nurses working in neonatal intensive care units across 19 countries. The studies described four main competence themes: 1) neonatal care interventions; 2) caring for a dying infant; 3) family-centered care; and 4) neonatal intensive care interventions.

CONCLUSION

Previous research has focused on evaluating specific competencies that are necessary in the neonatal intensive care setting. There is a need for research concerning the overall competence of nurses working in neonatal intensive care units. There was a lot of variety within the quality of the eligible studies and within the used instruments.

PROTOCOL REGISTRATION

This systematic review was registered in Prospero (PROSPERO 2022 CRD42022308028).

Nurses' clinical competency and its correlates: before and during the COVID-19 outbreak

BACKGROUND

Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic.

METHODS

We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered.

RESULTS

The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic.

CONCLUSION

The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses.

Development and psychometric testing of Perceived Preoperative Nursing Care Competence Scale for Nursing Students (PPreCC-NS)

BACKGROUND

For nurses to carry out their responsibilities related to preoperative care in the best possible way, it is very important for them to receive competency-based training and for their competences to be measured with reliable and valid tools in the training process.

OBJECTIVE

To develop a measurement tool that evaluates nursing students' perceived competence for preoperative nursing care.

DESIGN

A cross-sectional, methodological study.

SETTING

Two universities in the Eastern Black Sea Region of Turkey.

PARTICIPANTS

A total of 661 second, third and fourth grade nursing students participated in the study.

METHODS

Items were created in line with the nursing competencies published by the International Council of Nurses, the competencies in the perioperative period nursing practices published by the European Operating Room Nurses Association, and a review of the literature. Then, to test the content validity, the items were submitted for expert opinion and a pilot implementation was made with 50 nursing students. Furthermore, the construct validity of the scale was tested with exploratory factor analysis (n = 253) and confirmatory factor analysis (n = 350). Test-retest stability was also investigated for the PPreCC-NS (n = 58), in the study.

RESULTS

According to the results of the exploratory factor analysis, the Kaiser-Meyer-Olkin value was 0.948, and the Bartlett test χ2 was 7765.23; p < 0.001. Three items with a factor loading value below 0.50 were removed from the scale, and the obtained factor structure explained 62.25 % of the variance. The fit indices of the scale model tested in the confirmatory factor analysis were determined as χ²/df = 2.74, RMSEA = 0.07, CFI = 0.92, GFI = 0.88, AGFI = 0.85, IFI = 0.92. The structure of the draft scale was confirmed with 5 factors and 22 items. The Cronbach alpha values were found to be 0.79-0.96 for the sub-dimensions of the scale and 0.94 for the total scale. Data also showed a good test-retest stability (ICC = 0.72).

CONCLUSIONS

This scale is a reliable and valid measurement tool for nursing students to determine their level of perceived competence for preoperative nursing care. It is recommended that the psychometric structure of the scale be evaluated with further studies on larger and more diverse samples.

The Current Contexts of Newly Graduated Nurses’ Competence: A Content Analysis

Producing and sustaining a competent nursing workforce is imperative to protect the public. Identifying current issues and trends in nursing competence can strengthen insights and provide direction for the future nursing workforce. A summative content analysis was performed; PubMed, CINAHL, and Scopus were searched for content from the last ten years. A total of 3225 titles and abstracts regarding nursing competence were identified and analysed using the big-data analysis software Leximancer. Five themes were discovered from the analysis: (1) standardisation of nursing competencies with emerging competencies, (2) assessment competency levels, (3) graduates’ expectations and achievement, (4) safe and quality practice with teamwork, and (5) competency curriculum development. This found standardised nursing competencies, which suggests prioritising which core competencies should be focused on during education to produce competent generalist professional nurses, and employers could help nursing graduates improve their competence in specialised areas. This review also suggests that further education strategies should be developed to better prepare graduates for culturally safe practice to meet the needs of diverse minority populations and for informatics competency during the COVID-19 pandemic. Competence assessment methods must be extensively investigated to measure nursing competencies both longitudinally and cross-sectionally.

The training needs of critical care nurses: A psychometric analysis

BACKGROUND/OBJECTIVE

Nurses develop the care methods they learn through specific training and this enables them to provide care in a safe, effective and efficient manner. Intensive Care Units (ICU), as complex areas in terms of care, require nurses with specific training. Due to this fact, we set ourselves the objective to validate a questionnaire that detects the training needs of intensive care nurses in Spain.

METHODS

A cross-sectional descriptive study, using an electronic questionnaire, adapted and validated through the Delphi technique, in 85 ICUs in Spain, for which a psychometric analysis is conducted. To explore the dimensions and determine the factorial structure, an Exploratory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were carried out. Internal consistency was determined through ordinal alpha. The statistical treatment was carried out using the statistical programmes Factor Analysis 10.9.02 and IBM AMOS version 24.

RESULTS

A total of 568 Spanish intensive care nurses, randomly divided into two samples, participated in the study. The EFA presented a factorial solution with suitable values for both the Kaiser-Meyer-Olsen Index and Bartlett's Sphericity. In the CFA, the model fit achieved close to ideal values with a Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) close to values of 0.9. The values of individual reliability, internal consistency and average variance extracted were appropriate for this type of analysis.

CONCLUSION

The dimensions detected are close to the construct that encompasses the training needs of ICU nurses. The analyses carried out indicate that there are reasonable realities for incorporating these dimensions into the field of nursing training. This study opens the possibility of incorporating new items to adjust the model to improve the explanatory variables. Our findings help us to understand the dimensions that the training programmes should incorporate.

Assessment methods and tools to evaluate postgraduate critical care nursing students' competence in clinical placement. An integrative review

AIM

To provide an overview of assessment methods and tools to evaluate postgraduate critical care nursing students' competence in clinical placement and to identify recommendations for future assessment methods.

BACKGROUND

The purpose of postgraduate critical care nursing education is to educate professional, competent and caring critical care nurses and high-quality assessment strategies in clinical placement are of most importance.

DESIGN

An integrative review following Whittemore and Knafl's framework and Prisma 2020 guidelines for systematic reviews.

METHODS

Systematic searches were performed in June 2020 with an update in April 2021 using the following: Academic Search Premier, British Nursing Index, CINAHL, MEDLINE, SveMed+, Web of Science and the Joanna Briggs Institute databases. The systematic literature search and hand search yielded 380 studies. After screening and checking for eligibility, fifteen studies published between 2005 and 2020 were included in this review. The included studies were critically appraised using the Mixed Methods Appraisal Tool for empirical studies and the Joanna Briggs Institute Critical Appraisal tool for literature reviews.

RESULTS

Four qualitative, six quantitative, three mixed-methods and two literature review studies were included in this review. We identified that competence in postgraduate critical care nursing is a multidimensional concept and it is recommended to use a combination of assessment methods like self-assessment, observation and mentor evaluation. It is necessary to have discussions and reflections between the student, preceptor and lecturer, as well as written self- and mentor evaluation to provide formative and summative feedback to the students. The need to provide consistency and objectivity resulted in the development of competency assessment tools and they were mostly developed and validated as a collaboration between clinical sites and educational institutions. Most of the assessment tools consisted of domains reflecting holistic nursing, including both technical and non-technical skills. Domains reflecting evidence-based nursing practice were less common.

CONCLUSIONS

We need valid and reliable instruments to assess postgraduate critical care nursing student's competence in placement. Innovation and further research regarding effective and accessible assessment methods, such as digital assessment tools, are needed to meet future needs. This may also stimulate collaboration to improve the international inconsistency in critical care nursing educations. We should be working towards common, international educational competence descriptions and assessment tools that are in line with the ever-changing critical care environment, including holistic nursing and continuous learning.

Personality traits affect critical care nursing competence: A multicentre cross-sectional study

OBJECTIVE

To investigate the relationship between personality traits and critical care nursing competence among critical care nurses.

RESEARCH METHODOLOGY/DESIGN

Multicentre cross-sectional survey using a self-report questionnaire and path modelling, from August 2017 to December 2018.

SETTING

Six intensive care units in Japan.

MAIN OUTCOME MEASURES

We assessed relationships among the Big Five personality traits and four critical care nursing competencies in nurses.

FINDINGS

We included 211 nurses (77.7% women, 59.2% in their 20 s); 62.6% had 1-5 years' critical care nursing experience. Among the four competencies, principles of nursing care had a direct positive effect on decision-making (0.77, p < 0.001); decision-making had a direct positive effect on collaboration (0.74, p < 0.001) and nursing interventions (0.77, p < 0.001). The personality traits openness to experience, agreeableness, and extraversion had a significantly positive effect (0.17, p < 0.05; 0.43, p < 0.001; 0.29, p < 0.01; respectively) on principles of nursing care, the key competency. The personality trait neuroticism had a direct or indirect negative effect on all four nursing competencies.

CONCLUSION

Nursing competence in the critical care setting is affected by personality traits. Our findings can be applied in nursing education to improve competence based on individual personality traits.

Developing and psychometric testing of the anaesthesia nursing competence scale

RATIONALE, AIMS, AND OBJECTIVES

The competence of nurses in anaesthesia care is important for the quality of anaesthesia nursing care and patient safety. However, there is a lack of psychometrically tested instruments to measure the competence. Therefore, this study aimed to develop and test the psychometric properties of an anaesthesia nursing competence scale (AnestComp) assessing nurses' competence in anaesthesia care.

METHOD

The scale development and psychometric testing had three phases: (1) based on literature reviews and the description of experts, competence areas were identified and items were created; (2) the content validity of the scale was tested by a content expert group, and the scale was pilot tested; and (3) psychometric testing of scale was tested by anaesthesia nurses' (n = 222) and nursing students' (n = 205) self-assessments. The psychometric testing assessed the reliability when using Cronbach's α and the construct validity using factor analyses (confirmatory and exploratory) and known-group technique. Nursing students were included for the purpose of construct validity testing.

RESULTS

The AnestComp has 39 items and consists of seven competence areas: (a) ethics of anaesthesia care, (b) patient's risk care, (c) patient engagement with technology, (d) collaboration within patient care, (e) anaesthesia patient care with medication, (f) peri-anaesthesia nursing intervention, and (g) knowledge of anaesthesia patient care. Cronbach's α values were high in all categories (0.83-0.95), and factor analyses and known-group technique supported a seven-factor model.

CONCLUSION

The initial results supported the reliability and construct validity of the AnestComp. The scale is considered a promising instrument for measuring anaesthesia nursing competence among anaesthesia nurses. Further research with larger and more diverse samples is suggested to refine the current psychometric evaluation.

Development of an easy-to-use questionnaire assessing critical care nursing competence in Japan: A cross-sectional study

BACKGROUND

Critical care nurses need a high level of medical competence, especially with regard to patient safety. There are several tools to measure general and critical care nursing competence, but the usability of these tools is inadequate because they include large numbers of questions. To maintain quality and safety in intensive care units (ICUs), it is necessary to be able to easily measure and evaluate critical care nursing competence. The purpose of this study was to develop an easy-to-use questionnaire assessing critical care nursing competence related to patient safety.

METHODS

A cross-sectional, descriptive, explorative study was designed to collect data from nurses working in six ICUs in tertiary hospitals in Japan. Data were collected from August 2017 to December 2018. The Critical Care Nursing Competence Questionnaire for Patient Safety (C3Q-safety) is a 22-item instrument designed to assess nursing competence related to patient safety in ICUs. Items were developed based on previous work related to critical care nursing competence and were adjusted based on a pilot study.

RESULTS

A total of 211 nurses working in ICUs participated in this study. Through descriptive statistics and factor analysis, the number of questions was reduced from 24 to 22. The C3Q-safety had four factors: decision making, collaboration, nursing intervention, and principles of nursing care. Cronbach's alpha ranged from 0.73 to 0.83. The four factors showed positive correlations with each other (0.47 to 0.72). Nurses licensed as certified nurses in intensive care and those with longer ICU work experience showed significantly higher scores on all four factors.

CONCLUSIONS

We developed an easy-to-use questionnaire to assess critical care nursing competence related to patient safety. The C3Q-safety was able to detect four areas of competence. The C3Q-safety will make it possible to easily measure critical care nursing competence and can be utilized for efficient education.

Characteristics of a critical care clinical placement programme affecting critical care nursing competency of baccalaureate nursing students: A structural equation modelling

AIM AND OBJECTIVES

To evaluate and determine the characteristics of a critical care clinical placement programme affecting the critical care nursing competency of baccalaureate nursing students.

BACKGROUND

The increase in global demand for competent critical care services and human resources translates to an educational focus in preparing students for their eventual role as critical care health professionals. Albeit clinical placement in critical care units can promote competency, evidence supporting such claim remains inadequate.

DESIGN

Cross-sectional, descriptive correlational design.

METHOD

Employing structural equation modelling, 236 randomly selected baccalaureate nursing students from a clinically intensive university in the Philippines were recruited from January-March 2016. A three-part online survey, composed of the robotfoto, Critical Care Nursing Rotation Evaluation Questionnaire, and Intensive and Critical Care Nursing Competence Scale, was completed. The STROBE checklist was followed in reporting this study.

RESULTS

Five characteristics of clinical placement were extracted as follows: sufficient clinical exposure, adequate area orientation, supportive clinical instructor, diversified medical cases and supplemental learning resources. Four characteristics affected critical care nursing competency and built a good model (χ² /df = 1.52; comparative fit index = 0.94; parsimonious normal fit index = 0.77; root mean square error of approximation = 0.047). Adequate area orientation had the most diverse influence on all competency domains, while supportive clinical instructor had the strongest positive influence on critical care nursing skill (β = 0.30, p = 0.005).

CONCLUSION

The model highlights the characteristics of a critical care clinical placement programme which influences critical care nursing competency among nursing students. It emphasised the importance of a supportive clinical instructor and adequate area orientation in promoting critical care nursing skills and values and attitude.

RELEVANCE TO CLINICAL PRACTICE

The proposed model highlights the role of clinical instructors and appropriate orientation which provides impetus in improving the clinical placement design to maximise competency development.

Critical care nurses' self-assessed patient observation skills: a cross-sectional survey study

BACKGROUND

Observing a patient's clinical condition is an important responsibility of critical care nurses and an essential component of their competence. Critical care nurses' patient observation skills contribute to patient safety and quality of care. These observation skills have not been assessed or measured previously.

AIM

The aim of this study was to measure the self-assessed level of critical care nurses' patient observation skills and to explore the factors associated with these skills.

STUDY DESIGN

This was a multicentre cross-sectional survey conducted in Finland.

METHODS

The sample consisted of critical care nurses working at Finnish university hospitals. The data were collected between September 2017 and January 2018 using an instrument developed for the study - Patient Observation Skills in Critical Care Nursing (visual analogue scale 0-100). Descriptive and inferential statistics were used to analyse the data.

RESULTS

A total of 372 critical care nurses (49%) responded. Finnish critical care nurses assessed their patient observation skills overall as excellent. The bio-physiological foundation was assessed as good, whereas skills in using observation methods and skills in recognizing changing clinical condition were assessed as excellent. Education for special tasks in intensive care units, information searching in scientific journals, working experience in critical care nursing and critical care nurses' perception of critical care as a preferred field of nursing were factors promoting patient observation skills.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

The study provided a novel instrument for measuring critical care nurses' patient observation skills. The instrument may be used as an assessment tool in clinical practice and education. Developing orientation and on-the-job training in intensive care units are essential in assuring critical care nurses' adequate patient observation skills. Patient observation skills could be developed during nursing education by providing students with opportunities for clinical training and applying patient cases in virtual learning environments.

Developing professional competence among critical care nurses: An integrative review of literature

BACKGROUND

Professional competence is the ability to base clinical decisions on prior experiences with particular clinical situations.

METHODS

An integrative review of the literature using the methodology of Whittemore and Knafl. The guiding question was: What is the extent and nature of the published literature on intensive care nurses developing professional competence?

RESULTS

This review analysed 21 peer-reviewed articles obtained from electronic databases. The three main domains of professional competence were managing situations, decision-making and teamwork. Three instruments, the Critical Care Competency Assessment instrument, the Self-Assessment Competence Tool, and the Intensive and Critical Care Nursing Competence Scale (intensive care unit), measure professional and/or clinical competence. Demographic factors are experience, education, age, figure tow near here certification status, gender and location.

CONCLUSION

Perception of self-competence, seeing beyond the technical aspects of care to the patient, and perceptions of and bonding with intensive care patients and their families are other facets of professional competence that warrant further study.

A national approach to medicines information research: A systematic review

BACKGROUND

The Finnish Medicines Agency Fimea published the first National Medicines Information (MI) strategy in 2012. For the purpose of implementing the MI strategy into practice by the national MI Network, a comprehensive inventory of MI research in Finland was needed.

OBJECTIVE

To systematically review literature on MI research conducted in Finland by analyzing and classifying the studies, and identifying the gaps in MI research.

METHODS

Medline, Scopus and Medic databases were searched for peer-reviewed MI publications by using key word screening criteria. The search and extraction process followed PRISMA Guidelines and covered the period from January 2000 to June 2016. Included studies were content analyzed according to MI practices identified, trends over time in research methodology and theory.

RESULTS

Included publications (n = 126) applied a variety of research methods, most often cross-sectional surveys (n = 51, 40% of all studies), but more than half of the studies were qualitative (n = 68, 54%). Twelve were intervention studies of which 6 were randomized and had a control group. Studies were categorized into: patient counseling in different settings (n = 45); MI sources and needs of medicine users (n = 25); healthcare professionals' (HCPs) competence in patient counseling and pharmacotherapy (n = 25); MI sources and needs of HCPs (n = 23); MI education and literacy (n = 13); and MI policies and strategies (n = 3). Most of the studies were descriptive, and only 6 studies applied a theory.

CONCLUSIONS

Regardless of some methodological pitfalls, MI research conducted in Finland since 2000 provides multifaceted understanding of MI practices and their development needs. Research should shift towards larger research lines having a stronger theory base and study designs to deepen the understanding of MI practices and behaviors, and effectiveness of MI in different healthcare settings. Future research should cover also the use of electronic MI sources and services which apply modern information technology to clinical decision making and medication reviews, national MI policy, MI literacy, MI needs of HCPs and consumers.

Antecedents and Consequences of Therapeutic Communication in Iranian Nursing Students: A Qualitative Research

In recent years, particular attention has been paid to nursing students' therapeutic communication (TC) with patients, due to a strong emphasis on patient-centered education in the Iranian healthcare reform. However, various studies have highlighted the poor communication of future nurses. Therefore, researchers have used qualitative methodology to shed light on the antecedents and consequences of nursing students' TC and promote it. We carried out a conventional content analysis using semistructured interviews with a purposefully selected sample of 18 participants, including nursing instructors, students, and patients in hospitals affiliated to Tehran University of Medical Sciences. “Communication readiness,” “predisposing factors,” and “continuity of care” were identified as the three major themes. “Communication readiness” consisted of “physical readiness,” “academic readiness,” and “developmental readiness.” “Predisposing factors” included “contextual factors” and “educational condition.” “Continuity of care” included “patient satisfaction” and “improving nursing student's motivation to communicate with patients.” “Communication readiness” and “predisposing factors” constitute the antecedents of nursing student's TC with patients, and “continuity of care” is considered as its consequence. More attention needs to be paid by the regulators to TC instruction in both theoretical and clinical educational curriculum. Furthermore, all nurses must be informed about the importance of TC in promoting patient outcomes and quality of care.

Psychometric properties of the Persian version of the Intensive and Critical Care Nursing Competence Scale version-1 (ICCN-CS-1)

Background

Nursing competence is highly related to patient outcomes and patient safety issues, especially in intensive care units. Competence assessment tools are needed specifically for intensive care nursing.

Objective

This study was performed to determine psychometric properties of the Intensive and Critical Care Nursing Competence Scale version-1 between Iranian Nurses.

Methods

The present study was a methodological research in which 289 nurses of Intensive Care Units from nine hospitals in Shahid Beheshti University of Medical Sciences in Tehran were selected between 2015 and 2016. The original version of the scale was translated into Persian and back-translated into English, and the comments of the developer were applied. The validity of the scale was the determined quality (content validity and face validity) and quantity (confirmatory factor analysis). Reliability of the scale was reported by Cronbach’s alpha coefficient and Intra class Correlation Coefficient. SPSS-PC (v.21) and LISREL (v.8.5) were used to analyze the data.

Results

The intensive and critical care nursing competence scale version-1 is a self-assessment test that consists of 144 items and four domains which are the knowledge base, the skill base, the attitudes and values base and the experience base, which are divided into clinical competence and professional competence. Content and face validity was confirmed by 10 experts and 10 practitioner nurses in the intensive care units. In confirmatory factor analysis, all fitness indexes, except goodness of fit index (0.64), confirmed the four-factor structure of the ICCN-CS-1. The results of the factor analysis, load factor between 0.304 and 0.727 items was estimated; only 4 items out of 144 items, that were loaded were less than 0.3 due to high Cronbach’s alpha coefficient (0.984–0.986), all items were preserved, no item was removed and 4 subscales of the original scale were confirmed.

Conclusion

The results of this study indicated that the Persian version of “The Intensive and Critical Care Nursing Competence Scale version-1” is a valid and reliable scale for the assessment of competency among Iranian nurses, and it can be used as a reliable scale in nursing management, education and research.

Patient safety in acute care: are we going around in circles?

This article provides a critical discussion examining why adult patients continue to unnecessarily deteriorate and die despite repeated healthcare policy initiatives. After considering the policy background and reviewing current trends in the data, it proposes some solutions that, if enacted, would, the authors believe, have a direct impact on survival rates. Health professionals working in hospitals are failing to recognise signs of physiological deterioration. As a result, adult patients are dying unnecessarily, estimated to be in the region of 1000 a month. This is despite international healthcare policy requiring practitioners to be appropriately trained to recognise the deteriorating adult patient and to intervene. A literature review centred on health policy for England from 1999 to 2015 was undertaken, with reference to international policy and practice. This article also draws on the authors' combined clinical experience, which is underpinned by relevant research and theory. The implications for nursing could be significant. Change is urgently required otherwise people will continue to die unnecessarily. Health professionals, healthcare organisations and international governments working together can prevent unnecessary deaths from happening within acute hospitals.

Intelligence Care: A Nursing Care Strategy in Respiratory Intensive Care Unit

BACKGROUND

Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients.

OBJECTIVES

The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU.

MATERIALS AND METHODS

This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient's reports and documents were used. Information saturation was determined as an interview termination criterion.

RESULTS

Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications).

CONCLUSIONS

Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges.

Basic Competence of Intensive Care Unit Nurses: Cross-Sectional Survey Study

Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1-5, 1 = poor and 5 = excellent) was employed among Finnish intensive care unit nurses (n = 431). Intensive care unit nurses' self-assessed basic competence was good (mean 4.19, SD 0.40). The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses' basic competence was their experience of autonomy in nursing care (F value 60.85, β 0.11, SE 0.01, and P ≤ 0.0001). Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses' experienced autonomy in nursing.

Design and validation of the INICIARE instrument, for the assessment of dependency level in acutely ill hospitalised patients

AIMS AND OBJECTIVES

The aim of this study was to establish the validity and reliability of an instrument (Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería) used to assess the dependency level in acutely hospitalised patients. This instrument is novel, and it is based on the Nursing Outcomes Classification.

BACKGROUND

Multiple existing instruments for needs assessment have been poorly validated and based predominately on interventions. Standardised Nursing Languages offer an ideal framework to develop nursing sensitive instruments.

DESIGN

A cross-sectional validation study in two acute care hospitals in Spain.

METHODS

This study was implemented in two phases. First, the research team developed the instrument to be validated. In the second phase, the validation process was performed by experts, and the data analysis was conducted to establish the psychometric properties of the instrument.

RESULTS

Seven hundred and sixty-one patient ratings performed by nurses were collected during the course of the research study. Data analysis yielded a Cronbach's alpha of 0·91. An exploratory factorial analysis identified three factors (Physiological, Instrumental and Cognitive-behavioural), which explained 74% of the variance.

CONCLUSIONS

Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería was demonstrated to be a valid and reliable instrument based on its use in acutely hospitalised patients to assess the level of dependency.

RELEVANCE TO CLINICAL PRACTICE

Inventario del NIvel de Cuidados mediante IndicAdores de clasificación de Resultados de Enfermería can be used as an assessment tool in hospitalised patients during the nursing process throughout the entire hospitalisation period. It contributes information to support decisions on nursing diagnoses, interventions and outcomes. It also enables data codification in large databases.

Developing and Testing the Standard of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT) for Critical Care Nursing Practice

BACKGROUND

Nurses working in critical care often undertake specialty education. There are no uniform practice outcomes for critical care programs, and consumer input to practice standards has been lacking.

METHODS

A structured multiphase project was undertaken to develop practice standards and an assessment tool informed by critical care nursing stakeholders as well as patients and families-the Standards of Practice and Evaluation of Critical-Care-Nursing Tool (SPECT).

RESULTS

Testing of the SPECT revealed adequate content validity index (CVI), domain CVI (range, 0.772 to 0.887), and statement CVI (range, 0.66 to 1.00). Reliability was adequate in terms of internal consistency (Cronbach's α > 0.864) and test-retest Spearman rank correlation (range, 0.772 to 0.887); intra-rater kappa agreement was significant for 102 of 104 statements with moderate agreement for 94.2% of statements.

CONCLUSION

The SPECT appears to have clinical feasibility, preliminary validity and reliability, and provides a clear definition for the expected practice level for graduates of a critical care education program.

Graduating nursing students' basic competence in intensive and critical care nursing

AIMS AND OBJECTIVES

To describe and evaluate the basic competence of graduating nursing students in intensive and critical care nursing.

BACKGROUND

Intensive and critical care nursing is focused on severely ill patients who benefit from the attention of skilled personnel. More intensive and critical care nurses are needed in Europe. Critical care nursing education is generally postqualification education that builds upon initial generalist nursing education. However, in Europe, new graduates practise in intensive care units. Empirical research on nursing students' competence in intensive and critical care nursing is scarce.

DESIGN

A cross-sectional survey design.

METHODS

A basic competence scale (Intensive and Critical Care Nursing Competence Scale, version 1) and a knowledge test (Basic Knowledge Assessment Tool, version 7) were employed among graduating nursing students (n = 139).

RESULTS

Sixty-nine per cent of the students self-rated their basic competence as good. No association between self-assessed Intensive and Critical Care Nursing-1 and the results of the Basic Knowledge Assessment Tool-7 was found. The strongest factor explaining the students' conception of their competence was their experience of autonomy in nursing after graduation.

CONCLUSION

The students seem to trust their basic competence as they approach graduation. However, a knowledge test or other objective method of evaluation should be used together with a competence scale based on self-evaluation.

RELEVANCE TO CLINICAL PRACTICE

In nursing education and in clinical practice, for example, during orientation programmes, it is important not only to teach broad basic skills and knowledge of intensive and critical care nursing, but also to develop self-evaluation skills through the use of special instruments constructed for this purpose.