Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.Siirretty Doriast

Interprofessional collaboration and lecturers´ working life periods: Evaluation of the outcomes and pilot study of Competent Teacher Scale (CTS)

Nowadays healthcare and engineering education should respond to the demands of the continuously changing working life. The aim of this study was to describe the outcome of the eHealth related working life period to the competence of lecturers (N=28) of vocational education and to pilot test the developed Competent Teacher Scale (CTS). The lecturers self-assessed as best competence domain “Practice orientation”, the second best competence they assessed “Interprofessional collaboration” and as third competence domain they assessed “Development of education”. The lecturers self-assessed “eHealth” as the worst competence domain in point of the content of competence according to InnoHealth project. The first version of CTS worked well as internal assessment purposes in the project and should be further developed and tested in future

Competence Assessment Instruments in Perianesthesia Nursing Care: A Scoping Review of the Literature

Purpose: To identify competence assessment instruments in perianesthesia nursing care and to describe the validity and reliability of the instruments.Design: A scoping review in a systematic manner.Methods: A search in CINAHL, MEDLINE, and ERIC was carried out to identify empirical studies from 1994 to 2015. A narrative synthesis approach was undertaken to analyze the data.Findings: Nine competence assessment instruments in perianesthesia nursing care were identified. The instruments used three types of data collection methods: Self-report, observation, and written examinations. The most commonly reported validity method was content validity involving expert panels and reliability tests for internal consistency and inter-rater's consistency.Conclusions: Integrating more than one data collection method may give support to overcoming some of the limitations, such as lack of objectivity and misinterpretation of the assessment results. In an ever-changing environment, perianesthesia nursing competence requires constant reassessment from the perspective of content validity, scoring methods, and reliability

Perushoidon osaamisen ja toteutumisen arviointi erikoissairaanhoidon vuodeosastolla - hoitotyön opiskelijoiden ja hoitotyöntekijöiden näkökulma

Tutkimuksen tarkoituksena oli hoitotyön opiskelijoiden ja sairaan-/lähihoitajien perushoidon osaamisen ja toteutumisen arviointi erikoissairaanhoidossa vuodeosastoilla. Tätä varten kehitettiin itsearviointiin perustuva POTA – mittari (Perushoidon osaamisen ja toteuman arviointi).  Tutkimus oli poikkileikkauksellinen kyselytutkimus, jossa käytettiin sähköistä ja paperista kyselylomaketta. Tutkimuksen kohderyhmän muodostivat harjoittelussa olevat hoitotyön opiskelijat (n=38) ja sairaan-/lähihoitajat (n=96) yhdessä yliopistosairaalassa.   Itsearvioitu perushoidon osaaminen (asteikolla 1-5) oli opiskelijoilla (ka 3,66) ja hoitajilla (ka 3,96) keskimäärin hyvää. Opiskelijoiden (ka 3,98) ja hoitajien (ka 3,95) mielestä perushoito toteutui (asteikolla 1-5) vuodeosastoilla hyvin. Hoitajan iällä ja työkokemuksella oli tilastollisesti merkitsevä positiivinen yhteys osaamisen kokonaisarvioon. Hoitajan iällä oli tilastollisesti merkitsevä positiivinen yhteys toteutumisen kokonaisarvioon, mutta työkokemuksella ei ollut. Opiskelijan iällä, työkokemuksella tai opintomenestyksellä ei ollut tilastollisesti merkitsevää yhteyttä osaamisen ja toteutumisen arviointeihin. Tulosten mukaan näyttäisi siltä, että POTA –mittari mittaa perushoidon osaamista ja toteutumista vuodeosastoilla luotettavasti.  Perushoidon osaamista ja toteutumista tulee jatkossa tutkia myös potilaiden itsensä, heidän läheistensä ja hoitotyön esimiesten näkökulmasta. Myös koulutusta tulee kehittää.&nbsp

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, beta 0.11, SE 0.01, and PPeer reviewe

Structures, processes and outcomes of specialist critical care nurse education: An integrative review

Objectives: The objective of this study was to review and synthesise international literature to reveal the contemporary structures, processes, and outcomes of critical care nurse (CCN) education. Method: An integrative review on specialist critical care education was guided by Whittemore and Knafl's integrative review steps: problem identification; literature search; and data evaluation, analysis, and presentation. Donabedian's Quality Framework (Structure-Process-Outcome) provided a useful analytical lens and structure for the reporting of findings. Results: (1) Structures for CCN education incorporated transition-to-practice and ongoing education programs typically offered by hospitals and health services and university-level graduate certificate, diploma, and masters programs. Structural expectations included a standard core curriculum, clinically credible academic staff, and courses compliant with a higher education framework. Published workforce standards and policies were important structures for the practice learning environment. (2) Processes included incremental exposure to increasing patient acuity; consistent and appropriately supported and competent hospital-based preceptors/assessors; courses delivered with a flexible, modular approach; curricula that support nontechnical skills and patient- and family-centred care; stakeholder engagement between the education provider and the clinical setting to guide course planning, evaluation and revalidation; and evidence-based measurement of clinical capabilities/competence. (3) Outcomes included articulation of the scope and levels of graduate attributes and professional activities associated with each level. The role of higher degree research programs for knowledge creation and critical care academic leadership was noted. Conclusions: Provision of high-quality critical care education is multifaceted and complex. These findings provide information for healthcare organisations and education providers. This may enable best practice structures and processes for critical care specialist training that meets the needs of industry and safely supports developing CCN expertise. There is an acknowledged tension between the expectations of governing bodies for policies, standards, and position statements to enhance quality and reduce care variance and the availability of high-quality evidence to underpin these across international contexts

Miten koulutus valmistaa tehohoitotyöhön?

Sairaanhoitajakoulutuksen laajuus, sairaanhoitaja AMK -tutkinto, on tällä hetkellä Suomessa ollut jo vuosia 210 opintopistettä ja täysipäiväisenä opiskeluna sen on suunniteltu vievän kolme ja puoli vuotta. Euroopassa on yhteisesti säädetty, että yksi opintopiste (1 ECTS, european credit transfer system) tarkoittaa kolmen vuoden päätomisto opiskelua

Competence Assessment Instruments in Perianesthesia Nursing Care : A Scoping Review of the Literature

Purpose: To identify competence assessment instruments in perianesthesia nursing care and to describe the validity and reliability of the instruments. Design: A scoping review in a systematic manner. Methods: A search in CINAHL, MEDLINE, and ERIC was carried out to identify empirical studies from 1994 to 2015. A narrative synthesis approach was undertaken to analyze the data. Findings: Nine competence assessment instruments in perianesthesia nursing care were identified. The instruments used three types of data collection methods: Self-report, observation, and written examinations. The most commonly reported validity method was content validity involving expert panels and reliability tests for internal consistency and inter-rater's consistency. Conclusions: Integrating more than one data collection method may give support to overcoming some of the limitations, such as lack of objectivity and misinterpretation of the assessment results. In an ever-changing environment, perianesthesia nursing competence requires constant reassessment from the perspective of content validity, scoring methods, and reliability.Peer reviewe

Tehohoitajan ammatillisen kehittymisen malli

Turvallinen ja laadukas tehohoitotyö edellyttää tehohoitajilta syvää ja laaja-alaista tietoperustaa sekä tehohoitotyössä tarvittavia erityisiä hoitotyön taitoja ja teknistä osaamista. Tehohoitajilla tulee olla asiantuntijuutta tehdä hyvin perusteltuja ja nopeita kliinisiä päätöksiä sekä tunnistaa ja käsitellä tehohoitotyössä esiin tulevia eettisiä ongelmia. Tässä artikkelissa kuvataan tehohoitajalta edellytettävää kompetenssia eli pätevyyttä, josta käytetään myös termiä "osaaminen", ja sen kehittymistä sekä arviointia