Making the move: from bedside to camera-side

The tele-intensive care unit (tele-ICU) uses sophisticated telemedicine technology and a remote team of critical care experts, including nurses, to provide continuous monitoring, assessment, and interventional services to a large number of patients across multiple ICUs. This new practice environment offers experienced critical care nurses an opportunity for career and knowledge expansion while reducing some of the physical and emotional risks encountered at the bedside. The role of the tele-ICU is still evolving but focuses on 4 areas of responsibility: performing virtual rounds, managing patient alerts, providing ICU support, and coaching or providing teaching moments. The transition from the bedside into the tele-ICU role can be complex as tele-ICU nurses encounter ICU acceptance barriers and a lack of or a change in professional identity. A formal orientation program focused on competency is necessary for the successful transition from bedside nurse to tele-ICU nurse.     

Professional Accountability in the Tele-ICU: The CCRN-E

The American Association of Critical-Care Nurses (AACN) is the world's largest specialty nursing organization. The AACN Certification Corporation provides credentialing to validate nursing practice in acute and critical care. The advent of tele-ICU nursing added a challenge to the application of certification in a new specialty area. Nurses working in a tele-ICU have many years of experience in hands-on acute or critical care nursing at the bedside. In their role as tele-ICU nurses, these skills are applied to the assessment, evaluation, and decision support of care for critically ill patients in various acute and critical care units from remote locations connected directly to the ICU through high-speed audio and video technology. This article outlines the journey of the advent of the CCRN-E (registered nurse in critical care) credential and its place in the new specialty of tele-ICU nursing practice.     

Factors associated with nurses' informatics competency

Informatics competency has become an essential requirement for nurses to fulfill their professional roles. This study examined the factors affecting informatics competency to help develop strategies to improve nurses' informatics practice. A cross-sectional survey was conducted in two tertiary teaching hospitals in Seoul, Korea. A questionnaire was designed to collect data on nurses' informatics competency, basic computer skills, attitudes toward computerization, and general characteristics. The response rate was 96.4% (350/363). Multiple regression analysis was performed to determine the characteristics affecting informatics competency. More than two-thirds of the nurses (69.2%) considered their overall informatics competency to be below average. They scored the highest on the informatics topics of security and confidentiality, and the lowest on telehealth. More than half (58.9%) rated their computer skills to be below average. Nurses had favorable attitudes toward computerization. Significant factors associated with informatics competency were basic computer skills and formal informatics education. The study findings suggest that the enhancement of basic computer skills and incorporation of informatics into formal nursing curricula are needed to improve the nurses' competency in managing and using healthcare information.     

Motivation and job satisfaction of Tele-ICU nurses

Introduction

Although the first tele-ICU has been in existence for more than 12 years, little is known about the work of tele-ICU nurses. This study examines sources of motivation and satisfaction of tele-ICU nurses.

Methods

A total of 50 nurses in 5 tele-ICUs were interviewed about reasons for working as a tele-ICU nurse and sources of satisfaction and dissatisfaction in their job.

Results

Nurses have different motivations to work in the tele-ICU, including the challenges and opportunities for new learning that occur while interacting with clinicians in the tele-ICU and the various ICUs being monitored. Tele-ICU nurses also appreciate the opportunities for teamwork with tele-ICU physicians and nurses. The relationship and interactions with the ICUs is sometimes mentioned as a dissatisfier. Some nurses miss being physically at the bedside, as well as interacting with patients and families.

Conclusion

Most tele-ICU nurses are satisfied with their job. They like the challenge in their work and the opportunity to learn. For some nurses, the transition from a bedside caregiver to an information manager can be difficult. Other nurses have found a balance by working part-time in the tele-ICU and part-time in the ICU.     

Emergency Medicine Residency Training in Electrocardiogram Interpretation

OBJECTIVES: A national survey of emergency medicine (EM) residency program directors (PDs) was conducted to review training and evaluation of residents in electrocardiogram (ECG) interpretation and to assess the attitudes of PDs toward establishing national criteria for ECG competency. METHODS: An eight-question multiple-part survey was mailed to all 122 EM PDs. The presence of a formal ECG curriculum, teaching formats, and methods to assess competency were queried. The PDs' opinions on developing a national ECG curriculum, standardized assessment tool, and competency requirement for graduation were solicited on a five-point Likert scale. RESULTS: Surveys were received from 87 (71.3%) of the 122 EM residency programs. Of the responding programs, 56 (64.4%) had a formal ECG curriculum. Only 18 (20.7%) programs stated that they test for ECG competency, and even fewer, ten (11.5%) programs, require that residents prove competency to graduate. Although 32 (48.3%) PDs endorsed the idea of a national ECG curriculum, 51 (58.6%) opposed the implementation of a national ECG examination for EM. Similarly, 50 (57.5%) PDs opposed a national ECG competency requirement for graduation. CONCLUSIONS: While a majority of EM residency programs surveyed have a formal curriculum for ECG interpretation, less than a fourth formally test their residents or require proof of competency. The majority of residency PDs oppose the development of a national ECG examination or competency requirement for graduation. Implementation of the Accreditation Council for Graduate Medical Education directive for the demonstration of clinical competencies will be challenging given the current position of PDs.     

Mental Health Learning Needs Assessment: Competency-Based Instrument for Best Practice

A learning needs assessment focused on psychiatric/mental health nursing competency development is a central component of nursing education in specialty mental health nursing practice. The provision of education for mental health nursing relies on the underlying assumption that the learning needs of experienced mental health nurses have been assessed and educational programs implemented to address educational needs for competency in professional practice. Few professional learning needs assessments have been developed to identify learning needs in mental health nursing practice. The majority of available professional learning needs assessments focus on medical nursing practice applications rather than the psychosocial aspects of a mental health assessment. The mental health field addresses very different assessment criteria such as knowledge of suicide assessment and therapeutic interventions. The purpose of this article is to present and describe the process of developing a learning needs assessment focused on competency development for the specialty practice of mental health nursing that addresses and resolves complex learning needs.     

Study of Queensland emergency department nurses' actions and formal and informal procedures for clients who self-harm

Emergency department nurses are often required to assess and manage the needs of people who self-harm. A survey of 352 nurses working within 23 major public and 14 major private emergency departments in Queensland, Australia, investigated the extent to which formal and informal procedures are available and the extent to which these procedures guide how nurses respond to clients who present with deliberate self-harm. The Risk Assessment Questionnaire was developed and found that nurses are frequently called to respond to clients presenting because of deliberate self-harm, but most have no formal training in this area. In some services there is a lack of formal and comprehensive procedures for assessment and treatment. Where procedures do exist, significant therapeutic areas related to assessment are not explored with clients. These findings have implications for continuing professional development activities, nursing education programs and clinical practice procedures.     

Collaboratively planning for medicines administration competency: a survey evaluation

hemingway s., baxter h., smith g., burgess-dawson r. & dewhirst k. (2011) Journal of Nursing Management  19, 366–376
Collaboratively planning for medicines administration competency: a survey evaluation Aims This survey evaluated the experiences of mental health nurses who had undergone assessment of their competence in the administration of medicines using established assessment frameworks. Background Medicines management activities have at times been widely criticized. Joint collaborations between Higher Education Authorities and the National Health Service in education and training can start to address some of these criticisms. Method A questionnaire using 22 closed and open response questions was distributed to 827 practising mental health nurses and 44 graduate mental health nurses. Results A total of 70 registered and 41 graduate mental health nurses who had completed the assessment of administration competency frameworks responded to the survey. Response rates were 24 and 96%, respectively. The assessment frameworks were received positively. Environmental factors were perceived as the main barrier to medicines safety; however, this was not reflected in how this aspect of the competency framework was perceived. Implications for nursing management The administration of medicines is an area of mental health and all fields of nursing practice that needs attention. The use of competency frameworks as outlined in the ‘Medicine with Respect Project’ is one strategy to achieve the improvement in this essential clinical skill.     

Enhancing effectiveness in assessing forensic nursing staff competency

Assessing the competency of forensic nurses is an evolving area of management practice. This article presents a performance-based model for the assessment process. Examples of competency assessment activities that can measure psychomotor skills, critical thinking, and interpersonal skills are discussed, along with a sample competency for a selected skill. Evaluation strategies and their effectiveness are also analyzed.     

The Effects of Health Information Technology Change Over Time: A Study of Tele-ICU Functions

Objectives

Longitudinal studies exploring the evolution of health information technology functions provide valuable information about how technology systems are integrated and exploited in situ. This study reports changes in the distribution of functions for a specific health information technology, the tele-ICU, over time. The studied tele-ICU provided care to six remote ICUs within a local geographic region in the same state and had nursing staff around the clock.

Methods

The intervention logs of tele-ICU nurses were collected during two discrete times and coded into nine emergent functional categories, who initiated the intervention and, if required, subsequent escalation. All coded functional categories were investigated for significant changes over time in the nursing logged interventions.

Results

A total of 1927 interventions were coded into the nine emergent functional categories. Seven of the nine categories (78%) were significantly different between 2005 and 2007. The functions of the tele-ICU system continue to change and develop over time.

Conclusion

These findings suggest that the tele-ICU increased support when ICU nurses were off the unit, inter-hospital coordinating and adherence to best practices, while simultaneously decreasing real-time support for ICU nurses. This research suggests that sustaining safety features in a new technology over time have post-conditions after implementation.     

Relating new graduate nurse competence to frequency of use

The healthcare workplace can be a stress-laden environment for new graduates and job performance indicators are an important sign of developing confidence and expertise that will lead to improved patient outcomes. What is not evident from nursing studies is whether new graduate nurse competencies relate to the frequency of their use. This study sought to determine the relationship between perceived nursing competence and self-assessed frequency of use by new graduate nurses. Three cohorts (n = 116) of new graduate nurses undertaking year-long transition to graduate practice programs responded to a questionnaire that utilised the 2001 ANCI competencies and the Nurse Competency Scale and a Visual Analogue scale to self assess their perceived competence and the relative frequency of use for specific competence items. Results indicate that a relationship exists between perceived competence and frequency of use and that research competency scores are substantially lower than all other categories of competency. Implications for education and practice indicate that assessment of nurse competency for the new graduate nurse should focus on the development of generic nursing competencies rather than current expectation of advanced and workplace specific nurse competencies.     

公共卫生护士核心能力评价指标体系的构建

目的 构建公共卫生护士核心能力评价指标体系,为培养及发展符合我国国情的公共卫生护士提供依据。方法 通过国内外文献回顾、半结构式访谈初步拟定公共卫生护士核心能力评价指标体系,以德尔菲专家咨询法对全国18名专家进行2轮函询,并对条目进行修改、补充及删减,采用百分权重法计算各级指标条目的权重。结果 2轮专家咨询的问卷有效回收率均为100%,专家意见提出率分别为89%和67%,专家权威系数为0.864,肯德尔和谐系数分别为0.172~0.404和0.198~0.422（P均<0.001）。最终形成的公共卫生护士核心能力评价指标包括一级指标5项（基本公共卫生实践能力、项目管理与实施的基本能力、突发公共卫生事件应急反应能力、流行病学调查能力、领导力）、二级指标26项、三级指标79项。结论 公共卫生护士核心能力评价指标体系具有科学性、可靠性、本土适宜性及实用性,明确了公共卫生护士准入条件和工作职责,为中国未来培养及发展高素质公共卫生护理人才提供参考和借鉴,也为医疗机构制订临床护士转岗培训方案及考核标准提供依据。     

Exploring the assessors' and nurses' experience of formal assessment of clinical competency in the administration of blood components

Blood transfusion, clinical competency, assessment, evaluation The change in nurse education from apprenticeship training to the higher education setting, has raised concerns about the lack of practical skills newly qualified nurses have on registration. Every practitioner must be able to administer blood components safely however, the Serious Hazards of Transfusion (SHOT) scheme have consistently demonstrated that 'wrong blood' incidents are the major cause of morbidity and mortality related to transfusion in the United Kingdom. As a result the SHOT working group have recommended that all practitioners should have their clinical competency formally assessed. This paper describes the development and evaluation of a tool for assessing clinical competency for staff involved in transfusing blood. The evaluation used a triangulated approach of phenomenology and survey. The tool was piloted in two different clinical settings by four registered nurses who each assessed two nurses. Individual semi-structured interviews were conducted to collate the nurses' and the assessors' experience of the process. The study participants were of the opinion that assessing clinical competency using a criterion-referenced tool gave practitioners the opportunity to relate theory to practice, promote best practice and encourage adherence to hospital transfusion policies. Formal assessment of clinical competency is therefore, a vehicle that could be used to promote safe transfusion practice, ensuring the safety of patients is paramount.     

Assessing student nurse clinical competency: will we ever get it right?

In 1997, a revised system was introduced at the University of Glamorgan, Wales, to assess student nurse clinical competency. This was firstly as a result of concerns that the previous system was based on limited documentary evidence, and, secondly as the Welsh National Board for Nursing and Midwifery issued new competency statements. This article reports an evaluative research study which aimed to determine whether the revised system was an effective measure of clinical competency. A series of focus groups were conducted with students, tutors and clinical preceptors to discuss their experiences of using the revised system. A content analysis was conducted of all evidence written by students to support the achievement of clinical competency. The findings of the focus groups indicated that each group had some initial problems with the assessment process. The main concern for all groups was lack of consistency and uncertainty in the assessment process. Although the introduction of written evidence to support clinical competency was welcomed, many felt that too much evidence was required. Content analysis of competency documentation aimed to compare student evidence and to determine whether there were inconsistencies in the assessment process. There were many variations in the evidence obtained from students, in particular the amount of evidence written by each student. The findings clearly indicate that further revisions are necessary to ensure that the system is implemented in the most effective way. The Fitness for Practice report (UKCC, 1999) has ensured that competency-based assessment is here to stay in the UK. Evaluative research of this type is important to ensure that we adopt the most suitable approach to assessing clinical competency.     

关于社区护士能力需求现象学研究

目的:探讨我国社区护士应具备的能力。方法:采用现象学研究方法,在北京市某3家社区卫生服务中心,采用目的抽样方法选取社区护士、社区护理管理者、社区医生及社区居民共23名进行半结构式访谈。结果:社区护士需要具备的能力包括综合护理能力、人际交往和沟通能力、评估分析能力、安全防护能力、协调管理能力、自主学习能力、教育指导能力以及研究能力。结论:社区护士需要具备各方面的综合能力,我国目前社区护士能力尚不能满足社会需求,需通过完善社区护理教育体系等,以提高能力。     

Learning needs assessment as a vehicle for integrating staff development into a professional practice model

Restructured nursing roles resulting from innovative professional practice models and participative governance systems create a demand for new and expanded competencies. The impact for nursing staff development is the concurrent requirement to develop programs that match the skill/competency requirements of nurses in emerging practice models. This article recounts how one nursing department implemented a learning needs assessment (LNA) process as a means of integrating staff development into professional nursing practice.     

消毒供应中心护士岗位胜任力评价量表的编制及信效度检验

目的 编制消毒供应中心护士岗位胜任力评价量表并检验其信效度。 方法 研究组将前期构建的消毒供应中心护士岗位胜任力评价指标（4个一级指标、58个二级指标）进行指标转换,形成消毒供应中心护士岗位胜任力评价量表。选取6名专家评定量表内容效度。2021年5月—6月,便利选取北京市3所三级甲等综合医院消毒供应中心34名护士进行预调查;2021年9月—10月,便利选取2个省市630名消毒供应中心护士正式调查并进行信效度分析。 结果 消毒供应中心护士岗位胜任力评价量表包括理论知识、操作技能、综合能力及个人特质4个维度,共60个条目,量表的内容效度指数为0.970,各条目的内容效度指数为0.830~1.000;探索性因子分析提取4个公因子,累计方差贡献率为71.51%。量表总的Cronbach’s α系数为0.989,折半信度为0.951,重测信度为0.840。 结论 构建的消毒供应中心护士岗位胜任力评价量表具有良好的信效度,可作为消毒供应中心护士岗位胜任力的评价工具,为制订相关培训与考核提供参考。