Assessing Emergency Nurses' Clinical Competency: An Exploratory Factor Analysis Study

Factors affecting the development of clinical nurses' competency: A systematic review

AIM

To synthesize and analyze the literature on nursing clinical competence to assess the factors affecting nursing clinical competency.

BACKGROUND

Nursing competence affects not only patients but also nurses themselves. Competent nurses contribute to patient safety. Prioritizing clinical competency enables nurses to deliver high-quality care. Clinical nursing competency is influenced by various factors including education and training, experience, professional development, clinical judgment, decision-making skills and communication.

DESIGN

This was a systematic review.

METHODS

This study utilized an extensive literature search of online databases, including SCOPUS, Web of Science and PubMed. This review followed the guidelines provided by the Effective Practice and Organization of Care (EPOC) Cochrane Group and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

RESULTS

This systematic review provided 20 valuable articles, with a total of 6273 participants across the 20 studies, including 18 cross-sectional studies and two descriptive-correlational studies, predominantly using quantitative research methods. The analysis revealed several key factors that significantly affect nurses' clinical competency. These factors included years of experience, workplace environment, theoretical knowledge and educational level, marital status, clinical training, job satisfaction, turnover intention, job stress and critical thinking.

CONCLUSIONS

Understanding and addressing these factors are crucial for enhancing nurses' clinical competence and ultimately improving patient outcomes. Further research and interventions should be directed towards promoting supportive work environments, continuous education and the development of critical thinking skills among nurses to optimize their clinical competencies.

Correlation between moral distress and clinical competence in COVID-19 ICU nurses

BACKGROUND

Nurses' clinical competence is one of the fundamental necessities for providing safe and effective care. Moral distress, as one type of occupational stressors, can affect various aspects of clinical competence, especially under conditions of complicated medical settings such as the coronavirus disease 2019 (COVID-19) epidemic. This study was conducted with the aim of determining the relationship between moral distress and clinical competence in nurses working in COVID-19 intensive care units (ICUs).

METHODS

The study was a cross-sectional study. A total of 194 nurses working in COVID-19 ICU affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, central Iran, participated in the study. Data were collected using Demographic Information Questionnaire, Moral Distress Scale, and Clinical Competence Checklist. Data were analyzed with SPSS20 using descriptive and analytical statistics.

RESULTS

The mean score of moral distress, clinical competence, and skills application were 1.79 ± 0/68, 65.16 ± 15.38, and 145.10 ± 38.20, respectively. Based on Pearson correlation coefficient, there was an inverse and significant relationship between the moral distress score and its dimensions with clinical competence and skills application (P < 0.001). Moral distress was a significant negative predictor that accounted for 17.9% of the variance in clinical competence (R² = 0.179, P < 0.001) and 16% of the variance in utilization of clinical competence (R² = 0.160, P < 0.001).

CONCLUSION

Considering the relationship between moral distress, clinical competence and skills application, to maintain the quality of nursing services, nursing managers can strengthen clinical competence and skills application by using strategies to deal with and reduce moral distress in nurses, especially in critical situations.

Evaluation of Clinical Competence and Job Satisfaction and Their Related Factors Among Emergency Nurses in Palestinian Hospitals

Introduction

Nurses are responsible for providing primary care to millions of patients, and emergency nurses serve on the frontline in providing care for mildly to severely critically ill patients.

Objectives

This study aims to assess and evaluate the clinical competence and its related factors among emergency nurses in Palestinian hospitals.

Methods

A cross-sectional study was conducted among 170 nurses working in the emergency units of hospitals in the West Bank, Palestine. Data collection utilized the Nurse Competence Scale, and the Job Satisfaction Scale.

Results

The results showed that only 33(19.4%) of the participants exhibited a good level of clinical competence, with none reaching the very good level. Among them, the highest proportion of good level 60 (35.3%) was in the helping role, while the lowest 38 (22.4%) was in ensuring quality. About 35% of nurses reported very low or low job satisfaction, while 58% had high or very high job satisfaction. Additionally, the results revealed a statistically significant relationship between clinical competence and job satisfaction (P < 0.05). Both clinical competence and job satisfaction were positively correlated with age and experience.

Conclusion

The study found a significant relationship between demographic characteristics (e.g., education, experience, and marital status) and clinical competency among emergency nurses. Notably, less than half of the participants demonstrated good clinical competency, with none reaching a very good level. The highest scores were observed in the helping role domain, while the lowest were in the ensuring quality domain. Furthermore, clinical competence was found to be significantly associated with job satisfaction. Consequently, enhancing nurses' clinical competency will lead to an improvement in the quality of patient care.

Self-Rated Emergency Core Nursing Competencies Among Emergency Nurses in Qassim, Saudi Arabia

Introduction Emergency situations require advanced and specialized knowledge and skills to handle urgent situations. However, there is a scarcity of literature on emergency nurses' competencies. We assessed the competencies of nurses working in the emergency departments of hospitals in the Qassim region. Methods A cross-sectional study was conducted among 213 nursing staff at the emergency departments of all government hospitals in the Qassim region. A standardized tool was adopted for data collection which encompassed sociodemographic and self-reported competencies in nine emergency nursing domains, reflecting the core competencies using a 5-point Likert scale. Data was collected through an online survey. SPSS version 26 (IBM Corp., Armonk, USA) was used for data analysis. Linear regression analysis was carried out to explore the factors associated with competencies.  Results A total of 213 nurses were included in the study with a mean age of 32.9±4.6 years. More than two-thirds of the nurses were female (69.5) and more than half were Saudi nationals. The mean experience of the participants was (6.3±3.7) years. The nurses at the emergency department had satisfactory knowledge about most of the core emergency nursing competencies with some areas such as genitourinary, gynecological assessment, and documentation being deficient. Increasing age, being non-Saudi, married and nurse supervisor were associated with higher competencies. Conclusions Nurses generally had satisfactory knowledge of most of the core competencies of nurses in the emergency department in the Qassim region. However, there were deficiencies in core competencies in some domains. There is a need to provide on-the-job training and coaching for emergency nurses to improve their competencies and the quality of emergency care in the hospitals.

The Relationship Between Perception of Good Death With Clinical Competence of End-Of-Life Care in Critical Care Nurses

Providing a good death can be one of the most important goals of end-of-life care. This study aimed to investigate the relationship between the concept of good death with clinical end-of-life care competence among intensive care nurses. The participants were 279 nurses in southeast Iran. The data were collected using the Nurses' Concept of Good Death Questionnaire and the Clinical Competency of End-of-Life Care Questionnaire. There was a positive, moderate, and significant correlation between nurses' concept of good death and their clinical competence in end-of-life care. Nurses who got higher scores on the concept of good death showed higher levels of clinical competence in end-of-life care. It is possible to take steps to improve nurses' concepts and knowledge through specialized educational interventions.

Adaptability and clinical applicability of UFS-QoL in Chinese women with uterine fibroid

Objective

To demonstrate the applicability and adaptability of uterine fibroid symptoms and quality of life (UFS-QoL) in assessing the efficacy of treatment in Chinese populations.

Methods

This is a secondary analysis of a prospective cohort study involving 20 Chinese hospitals and 2,411 Chinese women with fibroids. Patients completed UFS-QoL and short form-36 (SF-36) at pre-surgery, 6-month and 12-month post-treatments. Internal consistency of the quality of life assessed by the UFS-QoL questionnaire using Cronbach’s α coefficient (α). Principal axis factor analysis with orthogonal rotation was established to investigate relationships between items and subscales. Concurrent validity refers to the Spearman's correlation estimate of the correlation between UFS-QoL and SF-36. Using effect size and standardized response mean, the ability to detect change was evaluated by comparing pre- and post-6-month and post-12-month treatment scores.

Results

Exploratory factor analysis yielded six subscales (concern, activities, energy/mood, control, self-consciousness, and sexual function) with eigenvalues > 1 in UFS-QoL. A 63.61% total variance was explained by the test items. Ceiling effects of self-consciousness and sexual functioning subscales from UFS-QoL were > 15%. UFS-QoL showed a positive and moderate correlation with SF-36 to establish good concurrent validity. And showed good consistency reliability (Cronbach α > 0.7 in all subscales), ability to detect change after treatment. This excluded self-consciousness (α = 0.56), which demonstrated the lowest effect size (0.38) and standardized response means (0.38) 6- and 12-months post-treatment.

Conclusions

Symptom severity, activity, and mood subscales of the Chinese UFS-QoL were valid and reliable. However, the self-consciousness domain needs further investigation on cultural adaptation, such as cognitive debriefing for how Chinese interpret these questions.

The impact of the evaluations made by Mini-CEX on the clinical competency of nursing students

INTRODUCTION

Clinical competency is defined as one's capabilities in terms of knowledge, attitude and practice, and is a necessity for nursing practice. Evaluation is the inseparable part of the education process, without which the quality of education could not be measured. Considering the characteristics of clinical education and its impact on the clinical competency of students, as well as the importance of making precise evaluations of them using scientific, modern and efficient approaches, this study aims to investigate the impact of the evaluation made using Mini-Clinical Evaluation Exercise on the clinical competency of the nursing students of the School of Nursing and Midwifery Shahid Behesti University.

METHODS

This is a quasi-experimental study with a control group conducted on students who were taking courses "Nursing care for a sick child". The students were classified into the intervention and control groups using complete enumeration. The evaluations were made using Mini-Clinical Evaluation Exercise in the intervention group and the portfolio approach in the control group. The skills regarding patient (mother-child) education, IV therapy and medication were evaluated by checklists.

FINDINGS

The results showed that the mean score of clinical competency in the intervention group was significantly higher than that of the control group.

CONCLUSION

Considering the improvement of clinical competency in the intervention group, it is recommended to use Mini-Clinical Evaluation Exercise for the evaluation of students.

A Cross-sectional Study of Self-Perceived Educational Needs of Emergency Nurses in Two Tertiary Hospitals in Nairobi, Kenya

BACKGROUND

Many low- and middle-income countries lack resources for well-functioning emergency care systems. Emergency nurses interact with injured and critically ill patients as the first contact in many health care settings. However, insufficient training limits nurses from providing ideal emergency care. The purpose of this research was to highlight educational needs specific to nurses working in 2 emergency departments in Nairobi, Kenya.

METHODS

A descriptive cross-sectional study involving emergency units of 2 of the largest referral and teaching hospitals (Aga Khan University Hospital, Nairobi, and Kenyatta National Hospital) in Nairobi, Kenya, was conducted. Data were collected by using an adapted structured, self-administered questionnaire. The data were analyzed using descriptive statistics. The skills and competencies of the participants were assessed. In addition, the educational gaps and needs of the participants around emergency care such as trauma, cardiovascular diseases, and respiratory and neurological illnesses were described. Results were presented in frequencies and percentages.

RESULTS

The questionnaire response rate was 63.6% (n = 84). Most of the respondents held associate degrees in nursing (72.6%), whereas 19% had a bachelor's degree in nursing. Most respondents (84.5%) perceived themselves as being highly competent in basic skills such as performing cardiopulmonary resuscitation and assessment of body systems. Less than half of the respondents (48.8%) perceived themselves as being highly competent in intermediate skills such as assisting with endotracheal intubation. In advanced competencies, such as analyzing electrocardiograms and administering thrombolytic medications, only 16.7% perceived themselves as highly competent.

CONCLUSION

The results of this study suggest there is a knowledge gap and educational needs among emergency nurses in Nairobi, Kenya. It identified injuries/trauma; cardiovascular, respiratory, and neurological disease; and other emergencies as topics of focus areas with a high need. To address these knowledge and skills needs, a future specialty training in emergency nursing is recommended and this could be achieved through continuing professional development and short courses or postgraduate-level training.

Clinical competence of Iranian nurses: A systematic review and meta-analysis

BACKGROUND

One of the most important steps in increasing the nurses' professional competence and consequently improving the quality of nursing care is to evaluate nurses' clinical competency and then take effective actions to enhance it. This study aimed at exploring the clinical competence of Iranian nurses and factors related to it.

MATERIALS AND METHODS

In this systematic review and meta-analysis, PubMed, Scopus, Web of Science, Scientific Information Database, and Iranmedex databases and Google Scholar search engine were searched to February 14, 2020.

RESULTS

After screening, a total of 25 articles were included. In general, the level of clinical competence of Iranian nurses was at a desirable level. After meta-analysis of the mean score of nurses' clinical competence, the combined mean was 161.13 (95% confidence interval [CI]: 137.78-184.48; P < 0.001; I ² = 99.8%; P value for heterogeneity = P < 0.001) by the Competency Inventory for Registered Nurses (CIRN) questionnaire. The summarized mean of clinical competency measured by the Nurse Competence Scale (NCS) questionnaire was 70.75 (95% CI: 60.80-80.70; P < 0.001; I ² = 99.9%; P value for heterogeneity = P < 0.001). Factors affecting nurses' clinical competence were age ≥33 years, nursing work experience ≥9 years, and a master's degree in nursing. However, the clinical competence of nurses had a significant negative relationship with job stress.

CONCLUSION

The level of clinical competence of Iranian nurses was desirable. Studies that used the CIRN, reported the highest and lowest clinical competence in clinical care and professional development dimensions, respectively. Studies that used the NCS, reported the highest and lowest clinical competence in dimensions of work role and ensuring quality, respectively.

A scoping review of Q-methodology in healthcare research

BACKGROUND

Q-methodology is an approach to studying complex issues of human 'subjectivity'. Although this approach was developed in the early twentieth century, the value of Q-methodology in healthcare was not recognised until relatively recently. The aim of this review was to scope the empirical healthcare literature to examine the extent to which Q-methodology has been utilised in healthcare over time, including how it has been used and for what purposes.

METHODS

A search of three electronic databases (Scopus, EBSCO-CINAHL Complete, Medline) was conducted. No date restriction was applied. A title and abstract review, followed by a full-text review, was conducted by a team of five reviewers. Included articles were English-language, peer-reviewed journal articles that used Q-methodology (both Q-sorting and inverted factor analysis) in healthcare settings. The following data items were extracted into a purpose-designed Excel spreadsheet: study details (e.g., setting, country, year), reasons for using Q-methodology, healthcare topic area, participants (type and number), materials (e.g., ranking anchors and Q-set), methods (e.g., development of the Q-set, analysis), study results, and study implications. Data synthesis was descriptive in nature and involved frequency counting, open coding and the organisation by data items.

RESULTS

Of the 2,302 articles identified by the search, 289 studies were included in this review. We found evidence of increased use of Q-methodology in healthcare, particularly over the last 5 years. However, this research remains diffuse, spread across a large number of journals and topic areas. In a number of studies, we identified limitations in the reporting of methods, such as insufficient information on how authors derived their Q-set, what types of analyses they performed, and the amount of variance explained.

CONCLUSIONS

Although Q-methodology is increasingly being adopted in healthcare research, it still appears to be relatively novel. This review highlight commonalities in how the method has been used, areas of application, and the potential value of the approach. To facilitate reporting of Q-methodological studies, we present a checklist of details that should be included for publication.

Nurses competence and hemodialysis adequacy achievement

Competence is defined as a combination of an individual's knowledge, attitude, and skills. Nurses, as the primary caregivers to hemodialysis patients, have an essential role in achieving hemodialysis adequacy. Hemodialysis adequacy achievement is one of the quality indicators of hemodialysis care. The research aims to identify the relationship between nurse competence and the achievement of hemodialysis in Bandung. The research design was correlation analytical with a cross-sectional method, which involved 82 hemodialysis nurses and 82 hemodialysis patients. Samples were using consecutive sampling. The data were analyzed using chi-square. The result shows that nurse's competence, especially nurse's attitude and skills in providing nursing care for hemodialysis patients, has a significant relationship with the achievement of hemodialysis adequacy. Nurses in the hemodialysis unit should improve their knowledge, attitude, and skills in providing nursing care.

Clinical competence in nursing: A hybrid concept analysis

BACKGROUND

Clinical competence (CC) is central issue in nursing. There are some controversies about this concept that needs further investigation. The present study was conducted to analyze the concept of clinical competence in nursing.

METHODS

This concept analysis was conducted using the three-phase hybrid model. In the theoretical phase, the Science Direct, PubMed, CINAHL, ProQuest, Scopus, Web of Science, SID, Iranmedex, and Magiran databases were searched to retrieve articles published from 2000 to 2020. Forty two eligible articles were included and analyzed. In the fieldwork phase, semi-structured interviews were held with eighteen university lecturers, clinical instructors, students, and hospital nurses and the data were analyzed through conventional content analysis. In the final analytic phase, the findings of the first and the second phases were combined.

RESULTS

The majority of literature defined CC in nursing as a combination of knowledge, and skills, and attitudes that is consistent with those of the fieldwork phase. Most participants in fieldwork stated that gaining CC is a process that is achieved over time through practice and repetition and increasing experience. A nurse needs to acquire personal, social and professional competencies during the study and work period. The CC has antecedents of efficient education, and organizational support. It also has consequences for patients and nurses such as satisfaction, and quality care.

CONCLUSION

CC is a continuous process of obtaining knowledge, values, and attitudes, and skills such as critical thinking skills that brings creativity and innovation in nursing practice.

Factors associated with core competencies of emergency-room nurses in tertiary hospitals in China

AIM

Quantitative studies using validated questionnaires on core competencies of emergency nurses in China are rare and the baseline core competencies must first be evaluated before improvizations to the competencies can be implemented. This study aimed to investigate the factors potentially involved in the level of core competencies of emergency nurses from tertiary hospitals in northwest China.

METHODS

In this cross-sectional study, male and female emergency nurses (n = 277) from tertiary hospitals of northwest China were enrolled to complete the Competency Inventory for Registered Nurses (CIRN) questionnaire comprising of a total of seven dimensions with 58 items. General self-efficacy and perceived stress were also evaluated. Pearson correlation test and multivariate stepwise linear regression analysis were performed to assess the association between various factors associated with core competencies.

RESULTS

Senior nurses had higher CIRN scores than junior nurses (p < .001). Married and widowed nurses had higher CIRN scores than unmarried and divorced nurses (p = .008). Nurses satisfied with their career had better CIRN scores than those who were dissatisfied (p < .001). CIRN scores were correlated with age (r = .356, p < .001), working years (r = .374, p < .001), and the general self-efficacy scale (r = .547, p < .001). Multivariable stepwise linear regression analysis showed that higher professional titles and job satisfaction were independently associated with higher CIRN scores (both p < .001).

CONCLUSIONS

Emergency nurses from tertiary hospitals of northwest China with senior titles and job satisfaction had high CIRN scores which necessitates empowering the junior nurses by way of education and training programs to gain higher core competencies in order to deliver better nursing care to patients.

Challenges and Barriers Affecting the Quality of Triage in Emergency Departments: A Qualitative Study

Background

Correct and fast triage is the key to successful performance in emergency departments. Various factors can affect the quality of triage; therefore, the present study was conducted to identify and explore the existing challenges in triage units in emergency departments.

Materials and Methods

The present study was a qualitative exploratory work conducted via the content analysis approach. Data were collected using in-depth, semi-structured interviews, and focus group interviews. Accordingly, 22 in-depth, semi-structured interviews were conducted in with 18 triage nurses and four emergency medicine specialists on a face-to-face basis.

Results

The challenges related to triage nurses fall into two subcategories; lack of clinical competency and psychological capabilities. The challenges related to emergency management consist of challenges in human resources management, structural, and performance.

Conclusion

The challenges existing in triage units are influenced by factors related to triage nurses and emergency management. Emergency administrators can improve the effectiveness and quality of triaging patients by empowering triage nurses and removing structural problems in triage units.

Evaluation of clinical competence and its related factors among ICU nurses in Kermanshah-Iran: A cross-sectional study

Objectives

The present study was conducted to evaluate the clinical competence and its related demographic factors among critical care nurses in Kermanshah, Iran.

Methods

In this cross-sectional study, 155 Iranian nurses were selected by stratified random sampling. The data collection tools included a personal information form and the “Nurse Competence Scale”. Data were analyzed using descriptive and analytical statistics.

Results

The mean score of nurses' clinical competence was equal to 76.14 ± 1.59 out of 100, which was at a “very good level”. The mean score of using clinical competence in practice was equal to 70.38 ± 15.25 out of 100, which was at a “good level”. Among the subscales of clinical competence, the highest mean score was related to “managing situation”. The mean score of “using clinical competence in practice” was related to the subscale of “therapeutic interventions”. There was no statistically significant difference among the score of clinical competence of nurses varying with different gender, age, academic degree, and work experience.

Conclusions

The clinical competence of critical care nurses in Kermanshah was at a “very good” level, and the use of clinical competence in practice was at a “good level.” Given the importance of clinical competencies in practice, nurses' clinical competence should be evaluated objectively and positive measures should be taken to promote the application of their clinical competence.

Professional competence of nurses in emergency services: evidence of content validity

OBJECTIVE

To verify the evidence of content validity of the Identifying Issues (Identification questions) elaborated from the theoretical-logical model of the Matrix and the Profile of Professional Competence of the emergency nurse.

METHOD

Descriptive and methodological study of a quantitative approach with a psychometric reference as a precursor in the elaboration of a measurement instrument for the evaluation of competencies. The study was conducted in 2013 in Brazil, with a national sample of nurses specialized in emergency services and/or with professional competence in the area. Three stages were considered: questionnaire development; data collection with Delphi, appropriate statistics for Likert; and interpretative analysis of the comments/suggestions of the analyzed issues.

RESULTS

Delphi was used in four stages. There were minor adjustments to the content and inclusion of a new Competence. They obtained 90% of Score Percentage and 98.61 of Content Validity Index.

CONCLUSION

There was consensus among the experts and the research demonstrated evidence of content validity, suggesting pertinence and adequacy to represent the constructs of competencies.

Validation of the Family Stability Questionnaire in married couples: a confirmatory factor analysis

Background

Marital conflicts and divorce are among the most crucial problems of society. Therefore, it is important to maintain family stability at the optimal level in order to prevent divorce and its consequences in the family and community.

Objective

This study was conducted to design and validate the Family Stability Questionnaire (FSQ) in married couples.

Methods

This study was the second stage of a large study. The FSQ was constructed based on a qualitative research in our previous study in 2016. It was developed through interviews by family therapists, psychiatrists, and couples on 10 dimensions (areas) and was based on McMaster’s Family Assessment Device (FAD). Then, in the present study, a confirmatory factor analysis was conducted on 270 males and females (135 couples) of Yazd City (Iran) from January to May 2017. The construct validity and reliability of the scales were examined using exploratory and confirmatory factor analyses (EFA and CFA) and Cronbach’s alpha coefficient, respectively. Test-retest reliability was assessed with intra-class correlation coefficients (ICC) for the agreement between the individual items and domains. SPSS 21 and AMOS 21 were used for statistical analyses (p≤0.05).

Results

At first, the results of the CFA on 70 items of FSQ could not confirm (RMSEA=0.06, CFI=0.91, GFI=0.72), but FSQ with 56 questions indicated that it had sufficiently high validity and reliability to measure family stability (RMSEA=0.04, CFI=0.95, GFI=0.96) with an acceptable fit index. A positive significant correlation was observed between the FSQ and FAD (r=0.45, p<0.001) indicating that FSQ has convergent validity. The Cronbach’s alpha and ICC of more than 0.7 in 10 domains of this tool indicated a good internal consistency among the items and their high relevance (0.90 and 0.84, respectively).

Conclusion

FSQ, as a multi-dimensional questionnaire, is a useful and reliable instrument to assess family stability. It consists of ten factors, which were constructed for the first time in Iran. Given the proper features, this instrument can be utilized to carry out more research regarding family stability in Iranian populations.