New nurse graduates' understanding of competence

This article describes the findings of a phenomenographic research approach used to understand the experiences of competence of new nurse graduates. The aim of phenomenography is to describe the qualitatively different ways in which people understand a phenomenon. Six new graduates, who had been employed in two paediatric metropolitan hospitals in Australia, participated in the research. The graduates were interviewed and asked to describe and draw their understanding of competence. The interviews were audio-taped and transcribed verbatim. Interview transcripts were analysed according to accepted phenomenographic methods of analysis. The graduates described eight conceptions of competence: competence as safe practice; competence as limited independence; competence as utilization of resources; competence as management of time and workload; competence as ethical practice; competence as performance of clinical skills; competence as knowledge; and competence as evolving. The final outcome of identification of conceptions led to the development of an outcome space (a diagrammatic representation of the logical relations between conceptions). The outcome space depicted a three-level hierarchical relationship between the eight conceptions of competence experienced within a global framework of safety. The findings contribute to nursing knowledge by describing the meaning of competence from the perspective of the new nurse graduate. The need for support and assistance by employers of new graduates is confirmed from the findings. New nurse graduate experiences of competence provide suggestions for improving undergraduate education programmes as well as clarification of entry-level competency standards

Cost-effectiveness of a central venous catheter care bundle

Background: A bundled approach to central venous catheter care is currently being promoted as an effective way of preventing catheter-related bloodstream infection (CR-BSI). Consumables used in the bundled approach are relatively inexpensive which may lead to the conclusion that the bundle is cost-effective. However, this fails to consider the nontrivial costs of the monitoring and education activities required to implement the bundle, or that alternative strategies are available to prevent CR-BSI. We evaluated the cost-effectiveness of a bundle to prevent CR-BSI in Australian intensive care patients. ---------- Methods and Findings: A Markov decision model was used to evaluate the cost-effectiveness of the bundle relative to remaining with current practice (a non-bundled approach to catheter care and uncoated catheters), or use of antimicrobial catheters. We assumed the bundle reduced relative risk of CR-BSI to 0.34. Given uncertainty about the cost of the bundle, threshold analyses were used to determine the maximum cost at which the bundle remained cost-effective relative to the other approaches to infection control. Sensitivity analyses explored how this threshold alters under different assumptions about the economic value placed on bed-days and health benefits gained by preventing infection. If clinicians are prepared to use antimicrobial catheters, the bundle is cost-effective if national 18-month implementation costs are below $1.1 million. If antimicrobial catheters are not an option the bundle must cost less than$4.3 million. If decision makers are only interested in obtaining cash-savings for the unit, and place no economic value on either the bed-days or the health benefits gained through preventing infection, these cost thresholds are reduced by two-thirds.---------- Conclusions: A catheter care bundle has the potential to be cost-effective in the Australian intensive care setting. Rather than anticipating cash-savings from this intervention, decision makers must be prepared to invest resources in infection control to see efficiency improvements