Clinical Nurse Instructor Competencies: An Exploratory Study of Role Requirements

Background: Baccalaureate nursing education consists of theoretical and practical training that prepares students for the role of competent nursing care providers. The practical application of knowledge and skills is vital in nursing curricula worldwide. Nursing programs have changed over the last few decades and have become increasingly dependent on part-time Clinical Instructors (CIs) to teach the clinical components of the curricula. However, CIs receive minimal instruction to prepare for this complex role. It has been acknowledged in Canada that there is limited research to inform CI specific competencies. Purpose: The purpose of this research was to conduct an exploratory study to identify the CIs perceptions of the importance of the World Health Organization’s (WHO) nurse educator core competencies and their importance to the clinical teaching role. Methodology: This was an exploratory quantitative study. A self-report survey was developed guided by the WHOs Nurse Educator Core Competencies (NECC). Donabedian’s structure-process-outcome conceptual framework guided this study. Sample and setting: Convenience sampling of participants employed as CIs in a baccalaureate in nursing program in an Ontario university. CIs who taught theory courses were excluded. The survey response rate was 23.9% (n=27). Results: The study results confirm that all the NECC have merit but need to be adapted to a CI-specific role. This is a multi-phased research project and the findings of the study have implications for all stakeholders, including schools of nursing and CIs. Ongoing research is required to inform the policy direction as it pertains to the CI-specific role and competencies in Canada. Implications for nursing programs, research and policy will be shared. Conclusions: Clinical Instruction is an area of nursing which deserves to be acknowledged as a specialty. National standardized CI-specific competencies will provide a strong foundation for CI preparation in Canada. Contexte : Le baccalauréat en sciences infirmières comprend des cours théoriques et pratiques préparant les étudiantes au rôle de professionnelles compétentes en soins de santé. Dans les programmes d’études en sciences infirmières partout dans le monde, l’application pratique des connaissances et habiletés est essentielle. Les programmes de sciences infirmières se sont transformés au cours des dernières décennies, dépendant de plus en plus des enseignantes de clinique (Clinical Instructors; CI), à temps partiel, pour le volet pratique du programme d’études. Ces enseignantes reçoivent toutefois très peu de soutien pour les préparer à jouer ce rôle complexe. Au Canada, il a été reconnu que peu de recherches renseignent sur les compétences spécifiques des enseignantes de cliniques. Objectif : Cette étude exploratoire avait pour but d’identifier les perceptions des enseignantes de clinique quant à l’importance des Compétences essentielles des infirmières enseignantes (Nurse Educator Core Competencies; NECC) décrites par l’Organisation mondiale de la Santé (OMS) ainsi qu’à leur importance pour le rôle d’enseignante de clinique. Méthode : Il s’agissait d’une étude quantitative exploratoire. Un sondage a été élaboré en s’appuyant sur les compétences essentielles des infirmières enseignantes de l’OMS. Le cadre conceptuel « structure-processus-résultats » de Donabedian a guidé cette étude. Échantillon et milieu : Un échantillonnage de convenance a été constitué de participantes volontaires employées comme enseignantes de clinique dans un programme de baccalauréat en sciences infirmières d’une université en Ontario. Les enseignantes qui donnaient des cours théoriques étaient exclues. Le taux de réponse au sondage a été de 23,9 % (n=27). Résultats : Les résultats de l’étude confirment que toutes les compétences sont pertinentes, mais qu’elles doivent être adaptées au rôle spécifique propre aux enseignantes de clinique. Ce projet de recherche comporte plusieurs étapes, et les résultats de cette étude ont des retombées pour toutes les parties prenantes, y compris les écoles de sciences infirmières et les enseignantes de clinique. Les travaux devront se poursuivre afin d’orienter la politique en ce qui concerne le rôle et les compétences spécifiques des enseignantes de clinique au Canada. Les retombées pour les programmes de sciences infirmières, la recherche et les politique seront présentées. Conclusions : L’enseignement clinique constitue un domaine des sciences infirmières méritant d’être reconnu comme une spécialité. Des normes nationales de compétences spécifiques aux enseignantes de clinique serviront de base solide pour la préparation de ces enseignantes au Canada

e-Delphi Technique in Postgraduate Registered Nursing Education and Competency Development: A Scoping Review

Background: It is common for nursing programs in Canada to hire part-time clinical instructors (CIs) to teach the practical components of curricula. Although experts in their field, these Registered Nurses (RNs) don’t have any formal preparation in education. Additionally, there are no current established competencies for CIs in Canada. This void in the Canadian literature warrants a search of competency development using the e-Delphi technique. The e-Delphi technique is a commonly used surveying technique for competency development in healthcare. Objective: To understand the extent, range, and nature of evidence of the use of the e-Delphi technique and critically appraise its use in postgraduate nursing education and nursing competency development to establish the feasibility of application to clinical nurse educator competency (CNEC) development in Canada. Methods: Two independent researchers conducted a scoping review to determine the extent, range, and nature of evidence of the use of the e-Delphi technique and critically appraise its use in postgraduate nursing education and nursing competency development. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute Reviewers’ Manual were used to guide the review. Results: The main components of e-Delphi that were extracted from the literature for review included the purposes of the studies, background of expert panel members, methods of e-Delphi used, reported level of consensus, number of rounds to meet consensus, time between rounds of questions, number of participants and changing participants. The purposes of the reviewed studies demonstrated that e-Delphi is a preferred method for developing or revising competencies for post baccalaureate programs. However, the other key components that were extracted revealed much variation in the use of e-Delphi by researchers. Most importantly, researchers need to ensure they report on the backgrounds of the expert panel members, decrease the time between the survey rounds and avoid introducing new participants in later rounds of the surveys to ensure consistency and methodological rigour of e-Delphi. Conclusion: There are variations in how e-Delphi is used in the literature for competency development, but if the authors are transparent with all phases of the method used, it is evident that it can significantly contribute to the advancement of future CNEC development in Canada. Résumé Contexte : Il est courant pour les programmes de formation en sciences infirmières au Canada d’embaucher des formatrices et formateurs cliniques à temps partiel pour enseigner les composantes pratiques des programmes d’études. Bien que spécialistes dans leur domaine, ces infirmières et infirmiers ne détiennent aucune formation formelle en enseignement. De plus, il n’existe actuellement aucun référentiel de compétences établi pour les formatrices et formateurs cliniques au Canada. Ce vide dans les écrits canadiens justifie une recherche sur l’élaboration des compétences liées à la formation clinique à l’aide de la méthode e-Delphi, une technique de sondage en ligne fréquemment utilisée pour nommer et clarifier les compétences dans le domaine de la santé. Objectif : Comprendre l’étendue, la portée et la nature des données probantes de l’utilisation de la méthode e-Delphi et évaluer de manière critique son utilisation dans la formation après l’obtention du grade en sciences infirmières ainsi que le développement des compétences infirmières afin d’établir la faisabilité de l’application pour l’élaboration des compétences des formatrices et formateurs cliniques au Canada. Méthodes : Deux chercheuses indépendantes ont mené une revue de la portée pour déterminer l’étendue, l’éventail et la nature des données probantes de l’utilisation de la méthode e-Delphi et évaluer de manière critique son utilisation dans la formation après l’obtention du grade en sciences infirmières et le développement des compétences infirmières. Le Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR]) et le Joanna Briggs Institute Reviewers’ Manual ont été utilisés pour guider cette revue. Résultats : Les principales composantes de la méthode e-Delphi qui ont été extraites de la littérature pour la revue comprenaient les objectifs des études, les antécédents des membres du groupe d’experts, les méthodes e-Delphi utilisées, le niveau de consensus rapporté, le nombre de tours pour atteindre le consensus, le temps entre les tours de questions, ainsi que le nombre et les changements de participants. Les objectifs des études examinées ont démontré que la méthode e-Delphi est privilégiée pour développer ou réviser des compétences pour les programmes post-baccalauréat. Cependant, les autres composantes clés extraites ont révélé une grande variation dans l’utilisation de la méthode e-Delphi par les groupes de recherche. Plus important encore, ces derniers doivent s’assurer de rapporter les antécédents des membres du panel d’experts, de réduire le temps entre les cycles de sondage et d’éviter d’introduire de nouveaux participants dans les cycles ultérieurs des sondages afin d’assurer la cohérence et la rigueur méthodologique de la méthode e-Delphi. Conclusion : Il existe des variations dans la façon dont la méthode e-Delphi est utilisée et rapportée dans la littérature pour le développement des compétences, mais si il y a transparence à toutes les phases de l’utilisation de la méthode, il est évident qu’elle peut contribuer de manière significative à l’élaboration du futur référentiel des compétences des formatrices et formateurs cliniques au Canada

Real-time in vivo dosimetry in high dose rate prostate brachytherapy

Background and purpose: Single fraction treatments of 15 Gy or 19 Gy are common in HDR prostate brachytherapy. In vivo dosimetry (IVD) is therefore important to ensure patient safety. This study assesses clinical IVD and investigates error detection thresholds for real-time treatment monitoring. Materials and methods: IVD was performed for 40 treatments planned using intra-operative trans-rectal ultrasound (TRUS) with a MOSFET inserted into an additional needle. Post-treatment TRUS images were acquired for 20 patients to assess needle movement. Monte Carlo simulations of treatment plans were performed for 10 patients to assess impact of heterogeneities. Per-needle and total plan uncertainties were estimated and retrospectively applied to the measured data as error detection thresholds. Results: The mean measured dose was −6.4% compared to prediction (range + 5.1% to −15.2%). Needle movement and heterogeneities accounted for −1.8% and −1.6% of this difference respectively (mean values for the patients analysed). Total plan uncertainty (k = 2) ranged from 11% to 17% and per needle uncertainty (k = 2) ranged from 18% to 110% (mean 31%). One out of 40 plans and 5% of needles were outside k = 2 error detection threshold. Conclusions: IVD showed good agreement with predicted dose within measurement uncertainties, providing reassurance in the accuracy of dose delivery. Thresholds for real-time error detection should be calculated on an individual plan/needle basis

Importance of dynamic contrast enhanced magnetic resonance imaging for targeting biopsy and salvage treatments after prostate cancer recurrence

Purpose: Evaluate T2 weighted MRI (T2W), diffusion weighted imaging (DWI), and dynamic contrast enhanced MRI (DCE-MRI) for determining areas of prostate cancer recurrence to target biopsy or salvage treatment in patients previously treated with I-125 seed brachytherapy. Material and methods: MRI data from 15 patients, whose primary treatment was I-125 seed brachytherapy and who were subsequently treated with partial gland salvage high-dose-rate brachytherapy were retrospectively analyzed. Two radiologists independently reviewed imaging on two occasions blinded to clinical and biopsy information. At first review, the T2W and DWI sequences were assessed for likely presence of tumor and at second review, the additional DCE-MRI sequence was assessed. Results were recorded and compared on a prostate diagram divided into 12 sectors (quadrants at each of base, mid-gland, and apex) plus seminal vesicles (SV). Results: Number of patients for whom recurrence was visible was 7/15 for T2W, 6.5/15 for DWI, and 15/15 for DCE-MRI (average of results for the two radiologists). Approximately, half of the sectors identified as showing recurrence were at the anterior base of the prostate. Conclusions: In prostate cancer patients previously treated with I-125 permanent seed implants, DCE-MRI is superior to T2W and DWI in defining areas of recurrence, and should be used to target biopsy and for treatment planning of focal salvage therapies

Patchiness and Co-Existence of Indigenous and Invasive Mussels at Small Spatial Scales: The Interaction of Facilitation and Competition

Ecological theory predicts that two species with similar requirements will fail to show long-term co-existence in situations where shared resources are limiting, especially at spatial scales that are small relative to the size of the organisms. Two species of intertidal mussels, the indigenous Perna perna and the invasive Mytilus galloprovincialis, form mixed beds on the south coast of South Africa in a situation that has been stable for several generations of these species, even though these populations are often limited by the availability of space. We examined the spatial structure of these species where they co-exist at small spatial scales in the absence of apparent environmental heterogeneity at two sites, testing: whether conspecific aggregation of mussels can occur (using spatial Monte-Carlo tests); the degree of patchiness (using Korcak B patchiness exponent), and whether there was a relationship between percent cover and patchiness. We found that under certain circumstances there is non-random conspecific aggregation, but that in other circumstances there may be random distribution (i.e. the two species are mixed), so that spatial patterns are context-dependent. The relative cover of the species differed between sites, and within each site, the species with higher cover showed low Korcak B values (indicating low patchiness, i.e. the existence of fewer, larger patches), while the less abundant species showed the reverse, i.e. high patchiness. This relationship did not hold for either species within sites. We conclude that co-existence between these mussels is possible, even at small spatial scales because each species is an ecological engineer and, while they have been shown to compete for space, this is preceded by initial facilitation. We suggest that a patchy pattern of co-existence is possible because of a balance between direct (competitive) and indirect (facilitative) interactions

Review of progress in implementing the recommendations of Sir Gareth Roberts, regarding employability and career development of PhD students and research staff

The need for improvement in the development of research careers and researchers’ training in transferable skills was highlighted in two particular recommendations (numbers 4.2 and 5.3) in the 2002 report ‘SET for success: the report of Sir Gareth Roberts’ Review - the supply of people with science, technology, engineering and mathematics skills’ (Roberts, 2002). As a consequence of that review, Research Councils UK (RCUK)1 have invested about £120 million, usually referred to as ’Roberts’ Money’, in research organisations to address this concern in all research disciplines. The last ‘Roberts’ Money’ payment will be for the period up to March 2011; it was therefore proposed to assess the progress made with taking forward these specific recommendations. An independent panel was formed by RCUK to undertake this review in 2010. The terms of reference for the panel are in Annex A. In summary, the panel was asked to review progress made and to advise RCUK and the higher education (HE) sector about future requirements for the development and training of researchers. In the course of their review, the panel considered a wide range of existing reports, interviewed key stakeholders in the HE sector and elsewhere, as well as drawing on their own knowledge and expertise. This report presents the findings of the panel’s review

Stress related epigenetic changes may explain opportunistic success in biological invasions in Antipode mussels

Different environmental factors could induce epigenetic changes, which are likely involved in the biological invasion process. Some of these factors are driven by humans as, for example, the pollution and deliberate or accidental introductions and others are due to natural conditions such as salinity. In this study, we have analysed the relationship between different stress factors: time in the new location, pollution and salinity with the methylation changes that could be involved in the invasive species tolerance to new environments. For this purpose, we have analysed two different mussels’ species, reciprocally introduced in antipode areas: the Mediterranean blue mussel Mytilus galloprovincialis and the New Zealand pygmy mussel Xenostrobus securis, widely recognized invaders outside their native distribution ranges. The demetylathion was higher in more stressed population, supporting the idea of epigenetic is involved in plasticity process. These results can open a new management protocols, using the epigenetic signals as potential pollution monitoring tool. We could use these epigenetic marks to recognise the invasive status in a population and determine potential biopollutants

A review of the biocontrol programmes against aquatic weeds in South Africa

Biological control (biocontrol) against invasive macrophytes is one of the longest standing programmes in South Africa, initiated in the 1970s against water hyacinth, Pontederia crassipes Mart. (Pontederiaceae). Since then, 15 agent species (13 insects, one mite and one pathogen) have been released against six weeds, most of which are floating macrophytes, with excellent levels of success. The release of the water hyacinth planthopper Megamelus scutellaris Berg (Hemiptera: Delphacidae) in particular, has improved biocontrol prospects for water hyacinth since 2018. In the last decade, however, a new suite of submerged and rooted emergent invasive macrophytes has been targeted. The first release against a submerged macrophyte in South Africa, and the first release against Brazilian waterweed, Egeria densa Planch. (Hydrocharitaceae), anywhere in the world, was achieved with the release of a leafmining fly, Hydrellia egeriae Rodrigues-Júnior, Mathis and Hauser (Diptera: Ephydridae). Yellow flag, Iris pseudacorus L. (Iridaceae) and Mexican waterlily, Nymphaea mexicana Zucc. (Nymphaeaceae), have also been targeted for biocontrol for the first time worldwide, and are in the early stages of agent development. Post-release evaluations, long term monitoring and controlled experiments have highlighted the need for a more holistic approach to managing aquatic invasive plants in South Africa, whose presence is largely driven by eutrophication, resulting in regime shifts between floating and submerged invaded states

Differences in stress tolerance and brood size between a non-indigenous and an indigenous gammarid in the northern Baltic Sea

Differences in stress tolerance and reproductive traits may drive the competitive hierarchy between nonindigenous and indigenous species and turn the former ones into successful invaders. In the northern Baltic Sea, the non-indigenous Gammarus tigrinus is a recent invader of littoral ecosystems and now occupies comparable ecological niches as the indigenous G. zaddachi. In laboratory experiments on specimens collected between June and August 2009 around Tva¨rminne in southern Finland (59°500N/23°150E), the tolerances towards heat stress and hypoxia were determined for the two species using lethal time, LT50, as response variable. The brood size of the two species was also studied and some observations were made on maturation of juveniles. Gammarus tigrinus was more resistant to hypoxia and survived at higher temperatures than G. zaddachi. Brood size was also greater in G. tigrinus than in G. zaddachi and G. tigrinus matured at a smaller size and earlier than G. zaddachi. Hence, there are clear competitive advantages for the non-indigenous G. tigrinus compared to the indigenous G. zaddachi, and these may be further strengthened through ongoing environmental changes related to increased eutrophication and a warming climate in the Baltic Sea region