Critical care competencies

In the absence of nationally accepted critical care competencies, each educational institution providing critical care programmes is forced to define the essential competencies necessary for practice, leading to variations in expected practice and the emergence of 'postcode' competencies. This research report aims to build upon competency activity for all areas of nursing practice within critical care levels 1, 2 and 3. A functional analysis to elicit core critical care competency statements was conducted and a modified Delphi technique was used to generate consensus opinion from a pan-London purposive sample of nurses working in critical care. The functional analysis group identified four competency statements and elements of competencies. Consensus agreement of 80% was achieved with mean agreement scores that exceed 97%. A core critical care competency framework was refined and developed by expert nurses drawing on their own experience and knowledge of critical care nursing. The framework could be useful to: educationalists designing competency-based curricula; critical care managers as a tool for recruitment and retention and for education and training of staff; individual critical care nurses to facilitate continuous professional development.     

Nurse competencies for person-directed care in nursing homes

A national movement to transform U.S. nursing homes is occurring with the intent to support self-determination, dignity and choice for nursing home residents facilitated by the continuation of their routines and preferences. Ten competencies for nurses were identified to facilitate this culture change in nursing homes. These competencies are intended to: model resident-directed care; foster effective team work with direct care workers to solve problems and make decisions that support residents; and promote a positive work and home environment. The strategies used to identify and disseminate the ten competencies are described as well as implications of the competencies for practice, education, and research.     

Development of a palliative care education program in rural long-term care facilities

In North America, people 85 years and older are the fastest growing age cohort and long-term care homes are increasingly becoming the place of end-of-life care. This is especially true in rural communities where services are lacking. Staff in long-term care homes lack education about palliative care, but in rural areas, accessing education and the lack of relevant curricula are barriers. The focus of this paper is to describe an approach to developing and delivering a research-based palliative care education curriculum in rural long-term care homes. The approach included conducting a detailed assessment of staffs' educational needs and preferred educational formats; developing a 15-hour interprofessional curriculum tailored to the identified needs; and delivering the curriculum on site in rural long-term care homes. Staff confidence and participation in delivering palliative care increased. Based on work in northwestern Ontario, Canada, this approach can serve as a model for palliative care education in other rural areas.     

Developing a competency framework for critical care to match patient need.

The competency framework developed by the critical care education group of the London Standing Conference aims to serve every grade and level of practitioner. It is neither time specific nor static. The patient is the central focus of the framework and the elements of competence reflect patient need at any critical care level [Comprehensive Critical Care: A Review of Adult Critical Care Services, The Stationary Office, London]. A group of expert nurses have developed the competency framework, with widespread consultation and collaboration. This approach intended to develop consistency for critical care education and practice. It is envisaged that this will reduce pockets of repeated activity, which places huge demands on limited resources. The critical care competency framework was developed using the method of functional analysis. A plan for the future has been identified, including continued collaboration and consultation with Trusts and Higher Educational Institutions and the development of an online manual to support the competency framework. KEY POINTS: 1. Critical care delivery has been under close scrutiny and a number of key contemporary drivers have led to the development of this competency framework. 2. The development of a consistent pan-London approach to critical care education has been identified. 3. The patient is the focus of critical care delivery and therefore patient need is central to the critical care competency framework. 4. Wider collaboration is needed with other agencies and groups to prevent the repetition of work already carried out.     

The palliative care education needs of nursing home staff

BACKGROUND: Palliative care is delivered in a number of settings, including nursing homes, where staff often have limited training in palliative care. AIM: We explored the level of palliative care knowledge among qualified staff delivering end-of-life care in nursing home settings, to inform the development of an appropriate education and training programme. DESIGN: An audit of the educational needs assessment was performed using an anonymous postal questionnaire sent to 528 qualified nursing staff within 48 nursing homes. FINDINGS: In total, 227 questionnaires were returned giving a response rate of 43%. Results indicated that less than half the sample had obtained formal training in the area of pain assessment and management and less than a quarter had obtained training in non-malignant conditions. Registered nurses in this study reported a lack of awareness of palliative care principles or national guidelines. CONCLUSION: Qualified nursing home staff agree that palliative care is a valuable model for care in their setting. There are clear opportunities for improvement in nursing home care, based on education and training in palliative care. Results also support the need for enhanced liaison between nursing homes and specialist palliative care services.     

The impact and importance of clinical learning experience in supporting nursing students in end-of-life care: Cluster analysis

BackgroundNursing students are often expected to provide end-of-life care to patients during clinical practice. Little research has been conducted to examine the heterogeneity of the students and how learning outcomes are affected by their education experience and other demographic factors.AimThe aim of this study was to identify and compare groups of nursing students based on their demographics, clinical experience, knowledge, perceived competency, and attitude towards end-of-life care.MethodA group of 253 nursing students was asked to complete a cross-sectional survey to explore their clinical experience, knowledge, attitude, and perceived competency towards end-of-life care. Cluster analysis was used to determine whether specific groups of students could be identified within the study cohort.ResultsThree distinct clusters were identified. Students from the three clusters showed no significant differences in end-of-life knowledge. Significant differences were identified in clinical experience amongst the three clusters and in attitude and perceived competency within the clusters. The cluster of students that had greater clinical experience demonstrated higher perceived competency and a more positive attitude towards end-of-life care.ConclusionClinical experience was found to be crucial in enhancing the perceived competency and attitude of nursing students in end-of-life care.     

Developing competencies for multidisciplinary hospice and palliative care professionals in Korea

Purpose

Competency-based assessment helps to improve performance and to standardize education programs for hospice and palliative care professionals. This paper aims to report the process and results of developing the hospice and palliative care competencies by multidisciplinary experts in Korea.

Methods

The competency development task force team of Korean hospice and palliative care professionals was comprised of seven physicians, four nurses, two social workers, and two clergy. To build consensus regarding competencies, the team performed a two-round Delphi survey. The importance of competency domains was assessed by using a 5-point Likert scale. After the completion of the Delphi survey, final competency domains were decided in a consensus meeting.

Results

The competencies were composed of knowledge, skills, and attitudes. The competency domains were identified as the following: 11 domains and 16 subdomains for physicians, 11 domains for nurses, 5 domains and 15 subdomains for social workers, as well as 3 domains and 5 subdomains for spiritual care providers. The high importance domains were different by specialties. Physical care and treatment for physicians, symptom management for nurses, bereavement care for social workers, and communication for spiritual care providers were ranked as highly important. For nurses and spiritual care providers, attitude-related domains were ranked the highest in importance.

Conclusion

The competencies developed by multidisciplinary professionals are useful to identify the appropriate roles of each hospice and palliative care specialist involved in a team approach to patient care.     

The challenges and opportunities in providing end-of-life care in nursing homes

Approximately 20% of deaths in the United States occur in nursing homes. That percentage is expected to increase as the population continues to age. As a setting for end-of-life care, nursing homes provide both challenges and opportunities. This article examines factors that impede the delivery of high-quality end-of-life care in nursing homes, such as inadequate staff and physician training, regulatory and reimbursement issues, poor symptom management, and lack of psychosocial support for staff, residents, and families. In addition to discussing hindrances to providing end-of-life care, this article explores characteristics of nursing homes and their staff that support the care of terminally ill residents. Also included is an overview of models for delivering end-of-life care in nursing homes, including provision of hospice services, specialized palliative care units, and consultation services. Finally, this article discusses educational programs and current educational initiatives to enhance end-of-life care in nursing homes.     

Analysis of end-of-life content in critical care nursing textbooks

Nurses have identified a need for improving their knowledge and skills in providing end-of-life care. Critical care nursing textbooks can serve as an important source of information on end-of-life care for critical care nurses. Hence, an analysis of end-of-life content in 14 critical care nursing textbooks was conducted. Critical care nursing textbooks used for review were published in 1995 or later and identified from the libraries at the University of Wisconsin-Madison and Brigham Young University. The end-of-life content areas identified by the American Association of Colleges of Nursing (AACN), under which the AACN end-of-life competencies for undergraduate nursing students can be taught, were used as a framework for assessing the presence or absence of end-of-life content in the textbooks. When end-of-life content was present, two reviewers judged whether the information was helpful. Four additional end-of-life content areas were identified in some textbooks during the study, and reviewers also judged whether these were helpful. None of the textbooks had end-of-life content in all the content areas used for the analysis. Three textbooks did not contain any end-of-life content.     

An education-service partnership to achieve safety and quality improvement competencies in nursing

The Institute of Medicine recommends that educational and service organizations develop partnerships to promote and prioritize competency development for nurses. This article describes a collaborative project between a college of nursing and a regional health care system. The project's aim was to foster the development of safety and quality by creating a curriculum based on the 10 core competencies identified by the Massachusetts Department of Higher Education Nurse of the Future Competency Committee. To accomplish this goal, learning experiences were created to address competency development. Competency-based education will help ensure that nursing graduates are adequately prepared to meet the current and future health care needs of our population.     

Competencies and skills for remote and rural maternity care: a review of the literature

AIM: This paper reports a review of the literature on skills, competencies and continuing professional development necessary for sustainable remote and rural maternity care. BACKGROUND: There is a general sense that maternity care providers in rural areas need specific skills and competencies. However, how these differ from generic skills and competencies is often unclear. METHODS: Approaches used to access the research studies included a comprehensive search in relevant electronic databases using relevant keywords (e.g. 'remote', 'midwifery', 'obstetrics', 'nurse-midwives', education', 'hospitals', 'skills', 'competencies', etc.). Experts were approached for (un-)published literature, and books and journals known to the authors were also used. Key journals were hand searched and references were followed up. The original search was conducted in 2004 and updated in 2006. FINDINGS: Little published literature exists on professional education, training or continuous professional development in maternity care in remote and rural settings. Although we found a large literature on competency, little was specific to competencies for rural practice or for maternity care. 'Hands-on' skills courses such as Advanced Life Support in Obstetrics and the Neonatal Resuscitation Programme increase confidence in practice, but no published evidence of effectiveness of such courses exists. CONCLUSION: Educators need to be aware of the barriers facing rural practitioners, and there is potential for increasing distant learning facilitated by videoconferencing or Internet access. They should also consider other assessment methods than portfolios. More research is needed on the levels of skills and competencies required for maternity care professionals practising in remote and rural areas.     

Palliative care nursing education: opportunities for gerontological nurses

Approximately 80% of Americans who die each year are 65 or older. Increasingly, gerontological nurses are asked to deliver high quality end-of-life care. Studies, however, have identified deficiencies in the delivery of care to older adults who are dying-particularly those who die in nursing homes. Enhancing nursing education and training in end-of-life care is one strategy proposed as a remedy for inadequate care for nursing home residents who are dying. This article reviews the current status of end-of-life nursing home care, describes the philosophy and components of quality palliative care, and provides information about opportunities and resources for educating gerontological nurses in end-of-life care.     

A new view: tele-intensive care unit competencies

BACKGROUND Many hospitals have well-planned nursing competency assessment programs, but these are meant to measure competency in traditional bedside roles, not in tele-intensive care unit (tele-ICU) nurses practicing remotely. OBJECTIVE To determine whether current tele-ICU programs have a formal competency assessment program and to determine when and how competency of tele-ICU nurses is assessed. Method A 20-question survey was provided to a convenience sample of the 44 known tele-ICU programs nationally. RESULTS Of the surveys distributed, 75% were completed and returned. A formal competency assessment policy for assessing nurses' competency at the time of hire, during orientation, and ongoing was in place at the workplaces of 85% of respondents. The most common methods for competency validation were performance appraisal and observation, although peer review and self-assessment also were used. Respondents identified the following competencies as the highest priorities for defining tele-ICU nurse practice: effective listening, prioritization, collaboration, and effective use of tele-ICU application tools. CONCLUSION Although awaiting development of professional practice standards, many tele-ICU programs currently measure the competence of tele-ICU nurses through competency programs.     

The effectiveness of an educational programme for nursing students on developing competence in the provision of spiritual care

Aim. To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. Background. Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. Design. Quasi‐experimental crossover design (pre–post‐test). Method. The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t‐test procedures (paired‐samples t‐test). At T₁ vignettes were added to assess the quality of the students’ own analyses. These data were analysed by a Mann–Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. Results. Ninety‐seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T₁) and over time for the whole cohort of students on all subscales (T₂). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. Conclusions. The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. Relevance to clinical practice. The results provide nurse educators with insight into the effects of education in spiritual care on students’ competencies and help them consider a systematic place for spiritual care within the nursing curriculum.     

End-of-Life Nursing Education Consortium. Geriatric Training Program: improving palliative care in community geriatric care settings

Recent studies of end-of-life care in nursing homes and other long-term care settings point to a significant need to improve care. The End-of-Life Nursing Education Consortium (ELNEC)-Geriatric Training Program is an important educational initiative to advance palliative care and end-of-life education for licensed nurses and nursing assistants. The ELNEC-Geriatric Training Program prepares nurses as educators and leaders to improve the quality of end-of-life care in geriatric care facilities. This article presents evaluation data from the 2007 pilot ELNEC-Geriatric Training Program and follow-up evaluation of the "train-the-trainer" model to disseminate comprehensive palliative care education in geriatric settings.     

Developing an empirical base for clinical nurse specialist education

This article reports on the design of a clinical nurse specialist (CNS) education program using National Association of Clinical Nurse Specialists (NACNS) CNS competencies to guide CNS program clinical competency expectations and curriculum outcomes. The purpose is to contribute to the development of an empirical base for education and credentialing of CNSs. The NACNS CNS core competencies and practice competencies in all 3 spheres of influence guided the creation of clinical competency grids for this university's practicum courses. This project describes the development, testing, and application of these clinical competency grids that link the program's CNS clinical courses with the NACNS CNS competencies. These documents guide identification, tracking, measurement, and evaluation of the competencies throughout the clinical practice portion of the CNS program. This ongoing project will continue to provide data necessary to the benchmarking of CNS practice competencies, which is needed to evaluate the effectiveness of direct practice performance and the currency of graduate nursing education.     

How to prepare Chinese-born nurses to care for patients at the end-of-life in Western settings: A discussion paper

BackgroundAs a result of globalisation, many Chinese-born nurses choose to work outside China. They are expected to be competent in providing end-of-life care and dealing with dying and death within the new country, where cultural beliefs, attitudes, and values towards dying and death may differ from their own. It is essential to consider the influence of Chinese culture on nurses’ confidence and preparedness for end-of-life care, especially for dealing with dying and death.PurposeTo discuss Chinese perspectives on dying and death, and death education and training in mainland China, from which we propose recommendations for nurse educators, clinical mentors and researchers in Western settings on how to prepare Chinese-born nurses to care for patients at end-of-life.DiscussionChinese-born nurses likely encounter significant cultural challenges when providing end-of-life care to dying patients in Western settings. Chinese-born nurses’ perspectives, attitudes and values toward dying and death are shaped by Chinese cultural and social beliefs, practices and expectations, which contrast with those of Western settings. Nurse educators, clinical mentors and researchers in Western settings are encouraged to support and guide Chinese-born nurses in building their cross-cultural understanding and world view to an international view of nursing; essential foundations to the provision of end-of-life care, and nurse coping with dying and death in Western settings.ConclusionThe development of death education programs and training to support Chinese-born nurses to attain their cultural competence is a priority in Western countries, to better promote these nurses’ competency in providing high-quality end-of-life care.     

Simulation in interprofessional education for patient-centred collaborative care

Title. Simulation in interprofessional education for patient‐centred collaborative care. Aim. This paper is a report of preliminary evaluations of an interprofessional education through simulation project by focusing on learner and teacher reactions to the pilot modules. Background. Approaches to interprofessional education vary widely. Studies indicate, however, that active, experiential learning facilitate it. Patient simulators require learners to incorporate knowing, being and doing in action. A theoretically based competency framework was developed to guide interprofessional education using simulation. The framework includes a typology of shared, complementary and profession‐specific competencies. Each competency type is associated with an intraprofessional, multiprofessional, or interprofessional teaching modality and with the professional composition of learner groups. Method. The project is guided by an action research approach in which ongoing evaluation generates knowledge to modify and further develop it. Preliminary evaluations of the first pilot module, cardiac resuscitation rounds, among 101 nursing students, 42 medical students and 70 junior medical residents were conducted in 2005–2007 using a questionnaire with rating scales and open‐ended questions. Another 20 medical students, 7 junior residents and 45 nursing students completed a questionnaire based on the Interdisciplinary Education Perception scale. Findings. Simulation‐based learning provided students with interprofessional activities they saw as relevant for their future as practitioners. They embraced both the interprofessional and simulation components enthusiastically. Attitudinal scores and responses were consistently positive among both medical and nursing students. Conclusion. Interprofessional education through simulation offers a promising approach to preparing future healthcare professionals for the collaborative models of healthcare delivery being developed internationally.