Core competencies of clinical nurse specialists: A comparison across three Nordic countries

The hotspots and trends of nursing master's education in China: a bibliometric analysis from 2000 to 2022

BACKGROUND

Graduate nursing education is the main way to train high-quality nursing personnel. Globally, the nursing education system has been gradually improved, forming a multi-level, multi-channel, and multi-specification education system including secondary, specialized, undergraduate, and postgraduate.

OBJECTIVE

To analyze the research hotspots and trends of nursing postgraduate education in China by using bibliometric methods, and to provide reference for scholars at home and abroad to understand the current status of this field.

METHODS

Literature related to graduate nursing education was searched in the Chinese full-text journal database (CNKI) from January 2000 to May 2022 and analyzed using CiteSpace software.

RESULTS

A total of 998 kinds of literature were included, with a growing trend in the number of articles issued. The research hotspots and trends of nursing graduate education in China are clinical practice, cultivation mode, and core competence.

CONCLUSION

Chinese nursing graduate education is improving. Foreign experience should be drawn upon, combined with the hotspots and trends summarized in this study, to promote the development of nursing graduate education in China.

A core competency evaluation index system for the graded use of clinical nurse specialists: A Delphi study

AIMS AND OBJECTIVES

To describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels.

BACKGROUND

Evaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession.

DESIGN

This research employed the Delphi method.

METHODS

The STROBE checklist for observational cross-sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications.

RESULTS

The graded competency evaluation system consisted of five first-level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision-making), 15 second level indicators, and 40 third-level indicators. The authority coefficients (Cr) of the experts were .865 and .901. The Kendall's concordance coefficients of the three-level indicators were .417, .289 and .316 for primary CNSs; .384, .294 and .337 for intermediate CNSs; and .489, .289 and .239 for advanced CNSs.

CONCLUSION

The graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral.

RELEVANCE TO CLINICAL PRACTICE

The evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs.

PATIENT OR PUBLIC CONTRIBUTION

Patients participated in the data collection process, during which they shared their health-seeking experience with our research team.

Construction of an index system of core competence assessment for otolaryngology nurse specialists in China: A Delphi study

BACKGROUND

Clinical nurse specialists play a vital role in the work quality, patient safety and team development of nurses. However, there is currently no prior study constructing the index of core competence assessment for otolaryngology Nurse Specialists.

OBJECTIVES

To establish an index system for the evaluation of Chinese otolaryngology Nurse Specialists' core competence.

DESIGN

A Delphi study.

SETTINGS

The study was mainly conducted in a university-affiliated hospital in China.

PARTICIPANTS

Twenty-two experts with otolaryngology knowledge and practical experience from different regions and organizations in China.

METHODS

We used literature reviews and expert meetings to establish a draft index system . Subsequently, a two-round Delphi survey was utilized to consult opinions from 22 experts about the index for the evaluation of otolaryngology nurse specialists' core competence and provide qualitative comments on their ratings. Consensus was predefined as a mean important score of 4.0 or above and a coefficient of variation is not above 0.25 among the participants.

RESULTS

The final evaluation indexes of the core competencies for otolaryngology Nurse Specialists included 5 first-level indexes (clinical competence, critical thinking competence, leadership, professional development competence, professionalism), 19 second-level indexes, and 85 third-level indexes. The effective response rates of the two expert consultation rounds were 100 %. The expert authority coefficients were 0.864 and 0.859 in the first and second rounds of consultation, respectively. In the second round of consultation, the first, second and third indexes of Kendall's coefficient of concordance were 0.357, 0.330, and 0.232, respectively (P < 0.001).

CONCLUSIONS

The constructed evaluation indexes of the core competencies of otolaryngology Nurse Specialists are scientific, reasonable, comprehensive, and specific and may provide references for the training and evaluation of otolaryngology Nurse Specialists.

Finnish Version of the Specialist Outcomes and Barriers Analysis Scale: Evaluation of Psychometric Properties

PURPOSE

To evaluate the psychometric properties of the Finnish version of the Specialist Outcomes and Barriers Analysis Scale.

DESIGN

This was a cross-sectional survey study.

METHODS

Cultural adaptation of the translation and content validity of the translated instrument were assessed by expert panelists (n = 5) using the content validity index. The construct validity was assessed with principal component analysis using the survey data of Finnish registered nurses (n = 60). Scale reliability was assessed with Cronbach's α values. All study phases were conducted in 2021.

RESULTS

The items (n = 59) of the scale were critically evaluated by the experts. The full-scale content validity was revealed as excellent (0.92). In terms of construct validity, the scale was analyzed separately for outcomes and barriers. The outcomes section revealed a 5-component structure with an overall Cronbach's α coefficient of .96, and the barriers section, a 2-component structure with an overall Cronbach's α coefficient of .82, indicating adequate reliability of the scale.

CONCLUSION

The Finnish version of the scale showed excellent content and construct validity. The Cronbach's α values represented adequate reliability of the Specialist Outcomes and Barriers Analysis scale when measuring nurses' perceived practice outcomes and barriers in the Finnish context.

An Integrative Review of Response Rates in Nursing Research Utilizing Online Surveys

BACKGROUND

Online surveys in nursing research have both advantages and disadvantages. Reaching a sample and attaining an appropriate response rate is an ongoing challenge and necessitates careful consideration when designing a nursing research study using an online survey approach.

OBJECTIVE

In this study, we aimed to explore response rates and survey characteristics of studies by nurse researchers that used online methodologies to survey nurses, nursing students, and nursing faculty.

METHODS

We conducted an integrative review of research studies that used online surveys for data collection published from 2011 to 2021. We examined response rates and survey characteristics such as recruitment method, use of incentives, question type, length of survey, time to complete the survey, and use of reminders.

RESULTS

Our review included 51 studies published by nurses with target samples of nurses, nursing students, or nursing faculty. Study sample sizes ranged from 48 to 29,283, the number of respondents ranged from 29 to 3,607, and the response rates ranged from 3.4% to 98%, with an average of 42.46%. Few patterns emerged regarding recruitment or other factors to enhance response rates; only five studies used incentives.

CONCLUSION

Response rates to online surveys are unlikely to reach the rates seen in older mailed surveys. Researchers need to design online survey studies to be easily accessible, concise, and appealing to participants.

Patients' and professionals' experiences with advanced practice nursing in cancer care: A qualitative study

PURPOSE

The growing complexity of cancer treatments requires changes in how care is organized and who provides it. The incorporation of advanced practice nursing roles within multidisciplinary teams can improve care in cancer patients. This study aims to understand the lived experience of cancer patients and multidisciplinary professionals in relation to the care provided by advanced practice nurses (APN).

METHODS

Phenomenological qualitative study. Data were collected through in-depth interviews and a field diary. Participants were recruited through convenience sampling; until theoretical data saturation was achieved. An interpretative phenomenological analysis was performed, following Guba and Lincoln's criteria for trustworthiness.

RESULTS

Interviews were performed with 18 professionals and 11 patients, from high-complexity public hospitals between March-December 2021. The main themes that emerged were: Advanced practice nurse role and competencies, Benefits provided by the APN, and Relevant aspects of nursing care.

CONCLUSION

Advanced practice nurses play a fundamental role in cancer care, making positive contributions to the patient experience and to the multidisciplinary team's work. Elucidating the contribution of advanced practice nurses in oncology will facilitate the definition of their specific competencies and, in turn, the implementation of training and management strategies to consolidate this figure in specialized centers.

Nurse specialist and ostomy patient: Competence and skills in the care pathway. A scoping review

AIMS AND OBJECTIVES

To summarise the evidence published to date regarding nursing core competence in stoma care of any type of ostomy throughout the patient's ostomy surgery candidate care pathway from preoperative to follow-up.

BACKGROUND

Nurses should play a key role in all ostomy patient care pathways to help them to adapt to the new physics and psychological conditions from the preoperative phases to the prevention of tardive stomal complications.

DESIGN

Scoping review.

METHODS

This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. The following databases were queried: PubMed, EMBASE and CINAHL, from August to October 2022.

RESULTS

The search strategy in the consulted databases identified 3144 studies. Different types of ostomies were found and investigated: tracheostomy, gastrostomy, jejunostomy, ileostomy, colostomy and urostomy. The results of the included studies helped address the objective that allowed the ostomatherapy skills to be broken down into the different periods of the care pathway.

CONCLUSION

Caring for an ostomy patient requires advanced skills and a trusting relationship. The skills outlined in this research suggest how essential the stoma care nurse specialist is in these patients' care.

Nursing boundaries and work identity construction among nurses exercising an advanced role: A qualitative study

Research on the deployment of advanced practice nurses (APNs) in healthcare settings highlights significant challenges for APNs transitioning to a broader, less well-defined nursing role in negotiating professional boundaries and a new work identity with other health workers. However, theories of boundary-work and professional identity have been rarely applied to APNs relationships with general nurses and colleagues in lower professional position such as nursing-assistants. APNs relationships with these colleagues remain poorly understood. This article aims to contribute to addressing this gap. It is based on qualitative research on a pilot-project prefiguring the introduction of APN (pre-APN) in the French Health system entitled the Prefiguration of Clinical Nurse Specialists (PrefICS). Data were collected through field observations and interviews with pre-APNs, general nurses, nursing-assistants, doctors and nursing hierarchy, to assess the implementation of PrefICS project in four hospitals, one health centre and one cancer control centre. The analysis shows that facing the risk of their role being limited to collaborations with doctors, pre-APNs engaged in different forms of boundary-work with general nurses and nursing-assistants, to negotiate new professional relationships with these colleagues. Some pre-APNs presented themselves as resource persons and led activities aimed at developing and sharing nursing knowledges and competencies with general nurses and nursing-assistants. Other pre-APNs shaped their work identity around a reformist role in terms of both the nursing profession and work environments. Pre-APNs boundary work with general nurses and nursing-assistants produced work spaces in which pre-APNs interwove their work identity with these colleagues by negotiating new professional ties and brokering knowledges between different professional worlds. Changes in levels of pre-APN self-categorization reflected different views of the nursing and nursing-assistant professions, from which pre-APNs started building new alliances for a shared reflective work on their practice and about caring.

Advanced practice nurse capabilities: A mixed methods systematic review

BACKGROUND

Global health challenges demand the optimal use of nurses' professional competence and capability. Competencies related to the roles of advanced practice nurses have been developed, but research on these nurses' capabilities remains limited.

AIM

To summarise and compare the literature on the capabilities of advanced practice nurses and the dimensions of these capabilities.

METHODS

We carried out a mixed methods systematic review, using CINAHL, PubMed, and Scopus to search literature published between 1998 and 2021. The quality of the selected articles was evaluated with the JBI Critical Appraisal Tools. We employed abductive content analysis, including deductive and inductive analysis. The reporting was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement.

RESULTS

Eleven articles out of 357 met the inclusion criteria. We identified all five dimensions of Hase and Davis's (1999) capability framework: can apply competencies in familiar as well as unfamiliar situations, is creative, has a high degree of self-efficacy, knows how to learn, and works well in teams. Additionally, we found a new dimension of capability: identifies factors affecting the scope of practice.

LIMITATIONS

This mixed methods systematic review was conducted about a little-studied topic. Because country-specific differences exist and consensus on advanced practice nursing roles is lacking, the concept of advanced practice nurse capabilities cannot be directly generalised.

CONCLUSIONS

Capability is a requirement and a necessity in the performance of advanced practice nurses. Identifying and defining the dimensions of advanced practice nurses' capabilities will lead the way in developing the roles, education, and capability assessments of advanced practice nurses. Identification of advanced practice nurses' capability will facilitate role understanding, visibility, and implementation in health care services. This can improve the quality and accessibility of care and improve the cost-effectiveness of the use of health care professionals.

Status of core competencies of wound, ostomy and continence nurses and their influence on career success: a cross-sectional study

OBJECTIVES

The wound, ostomy and continence nursing practice has its own scope and standards, and each standard requires relevant competency. However, the core competencies of wound, ostomy and continence nurses that contribute to the career success are poorly known. To identify associations between career success and core competencies of wound, ostomy and continence nurses in China.

DESIGN

A cross-sectional survey with a convenience sample.

SETTING

Participants were recruited from 108 hospitals in 28 provinces.

PARTICIPANTS

A total of 123 wound, ostomy and continence nurses were surveyed.

MEASURES

Career success, core competencies and demographic characteristics of wound, ostomy and continence nurses, were measured in this study.

METHODS

A survey was distributed to 123 wound, ostomy and continence nurses were recruited from 108 hospitals in 28 provinces. Multivariate logistic regression was undertaken to explore associations between career success outcomes and core competency scores of wound ostomy and continence nurses and their demographic characteristics.

RESULTS

The career success and core competency of wound, ostomy and continence nurses were both above average. Nurses who had higher total scores of core competency were more likely to have higher career success, including total score (OR=4.90), career satisfaction (OR=5.58) and perceived internal (OR=4.55)/external (OR=3.42) organisation competitiveness. Higher competency in interpersonal communication (OR=7.70) and more time for wound care per month (OR=8.80) predicted higher career satisfaction. Additionally, nurses with higher professional development were more likely to score higher in perceived internal organisation competitiveness of career success (OR=4.36) and the overall career success (OR=5.96).

CONCLUSIONS

The career success and core competency of the wound, ostomy and continence nurses in China were at an above average level. The associations between career success and core competency of the wound, ostomy and continence nurses were positive, suggesting that competency enhancement could improve nurses' career success.

Developing a professional competence framework for the master of nursing specialist degree program in China: A modified Delphi study

BACKGROUND

The urgency of ensuring adequate professional competence in clinical nursing practice is evident. However, there is little formal professional competence framework for the education of master's degree students in nursing specialist programs in China.

OBJECTIVE

To develop a professional competence framework for the Master of Nursing Specialist (MNS) degree program in China.

DESIGN

A modified Delphi study.

PARTICIPANTS

An expert panel discussion was held with 12 experts, and Delphi rounds were conducted with 24 experts.

METHODS

A literature review and an expert panel discussion were conducted to develop an initial competence framework. A two-round Delphi survey was employed to obtain a consensus on the framework through either an online or paper questionnaire. Descriptive statistics were used to analyze the data. The consensus threshold was set according to the mean (≥ 4.0), coefficient of variation (< 0.25), and consensus level of agreement (≥70 %).

RESULTS

A consensus on seven domains and 54 items of the professional framework for the MNS degree program was achieved. The framework domains included clinical practice (12 items), professional attitude (8 items), collaboration and communication (5 items), professional development (8 items), research (7 items), education (7 items), and administration (7 items).

CONCLUSION

The professional competence framework offers guidelines for MNS degree programs in China. Future research should focus on imbedding these competences in MNS degree programs to prepare qualified advanced practice nurses.

Delphi survey on the application of advanced practice nursing competencies: Strong points and unfinished business in cancer care

AIM

This study assessed the application of advanced practice nursing competencies in cancer care to identify obstacles to their full implementation.

BACKGROUND

Internationally, the implementation of advanced practice nursing roles depends on the context and environment, which shape the definition, scope and competencies associated with these roles.

METHODS

Nurses participated in two rounds of an online Delphi survey about the competencies of advanced practice oncology nurses. The threshold for expert consensus was set at 75%.

RESULTS

Eleven competency domains were proposed; all yielded consensus of over 75%. However, for 57.8% of the specific competencies proposed in round 1 and for 62.2% in round 2, there was no consensus on which were applied in practice. There was more agreement on the competencies applied in the domains of direct clinical practice, consultation and collaboration and interprofessional relations than in dimensions such as health care promotion, quality improvement, evidence-based practice and research. Barriers related to unimplemented competencies were identified.

CONCLUSIONS

The competencies applied in advanced practice nursing reflect incomplete development of these roles. Domains related to direct clinical practice, consultation and collaboration and interprofessional relations are relatively well developed, whereas those related to leadership, research, evidence-based practice and quality improvement are not. The identified barriers hindering implementation of some competencies can inform strategies to develop this role in cancer care.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital administrators and nurse managers should reflect and be mindful of the development of advanced practice nurse (APN) competencies along with the challenges associated with implementing advanced practice roles.

Outcomes and challenges of successful clinical nurse specialist role implementation: Participatory action research

AIM

To describe the clinical nurse specialist role and its outcomes and challenges.

DESIGN

Participatory Action Research conducted in Finland between the fall of 2017 and the end of 2018.

METHODS

A core participatory action research team (n = 10) led the design, implementation and evaluation of the research. Multiple data collection methods were used. The study is reported using the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines for participatory action research.

RESULTS

The clinical nurse specialist used most of the time in clinical patient care followed by clinical nursing leadership and scholarship activities. Outcomes of successful implementation led to increased visibility of nursing expertise, development, integration and quality assurance of nursing processes and practice, and promotion of knowledge translation and unit and collaborator cooperation. Furthermore, role challenges were also recognized.