Problems with competence assessment as it applies to student nurses

Nursing has enthusiastically embraced the concept of continuing competence as the key means of reassuring the public of the overall quality of the profession. There are many definitions of competence and a number of nursing regulatory bodies have put into operation, a definition which is reductionist rather then holistic in nature. Not surprisingly, and as a consequence many nurses, including nurse educators, think competence comprises a number of key competencies which can be isolated, accumulated and tallied. It is clear that both philosophically and practically these notions of competence have influenced the way that student nurses are currently educated. More specifically it is in preparation for their initial entry to practice that the approach to competence assessment of student nurses becomes problematic. In this paper it will be argued that the principles of continuing competence assessment, associated with the on going competence of experienced registered nurses, do not readily translate to students who are still in the process of learning. We suggest that solutions to this problem are three-fold and can be found by replicating for the student the conditions that apply to the assessment of continuing competence for registered nurses.     

Power and effective nursing practice

Underlying the Nursing Knowledge Program were the beliefs that professionals can be prepared to function more effectively in organizations and that organizations can be designed to promote better use of professional skills. The training program, therefore, included both educational and structural solutions for the problems of powerlessness experienced by nurses in the hospital setting. Educationally, the program was designed to empower the participating nurses by teaching them the analytic and interpersonal skills they needed to develop and implement plans for change. Structurally, it established new lines of communication between staff nurses and nurse administrators, linked the nurses to needed resources, and gave the nurses more control over working conditions. Due to the quasi-experimental nature of the research design used in the project, the findings cannot be generalized to all nurses in all hospitals. There is no question, however, that each of the four strategies can be a valuable administrative approach for increasing nursing power. Confirming the strategies and moving groups of nurses through a series of activities specifically designed to use the strategies can bring significant change in the perceptions of nurses about themselves and their profession. For the administrator, the strategies are a way to develop a more effective and satisfied nursing staff, to encourage new leadership, and to create a stronger constituency among staff members. They also create a new source of energy and ideas for resolving the very real problems of professional practice.     

An emancipatory study of contemporary nursing practice

Changes in health care facilities have created the necessity for individual nurses to change, eg, change jobs, pursue additional education, become independent entrepreneurs. There is a shortage of nurses that places stress on those who remain to care for an increasing number of persons with too few resources. The purposes of this study were to explore nurses' perceptions of the circumstances of their work lives and to describe the processes by which they can create change in these circumstances. The methodology was an emancipatory design combining tenets of critical inquiry and feminist research. The method used was a dialectical process of reflection and action (praxis). Three diverse groups of nurses met weekly over 6-10 weeks. Using the group process method, each group reflected on, discussed, and analyzed the phenomenon of practicing nursing today. The outcome of an emancipatory study is reflected in the power of the process. The group interaction increased awareness, promoted reflection on the status quo, and energized the groups to derive possible solutions to changing that status quo. It is not the solutions themselves that are as relevant as is the obvious cogency of the process to achieve individual and group emancipation. Six codifications reflected the themes that emerged and 5 processes for exploring untested feasibilities for change were identified. The participants perceived themselves more as subjects in their history than objects to be manipulated, capable of transforming a rather dismal situation of nursing practice into one that was critical, creative, and freer from constraints. The implication of this study is that nurses are encouraged to adopt and adapt this process of group interaction because of its demonstrated credibility to empower and validate the role that nurses have to derive and implement solutions to change their unsatisfactory status quo.     

Competition in school nursing: the development of the nursing role and its influences

This essay focuses on the competition between school nurses and the effect of such on the development of school nursing. As questions regarding the role that school nurses should play and what kind of functions they should have in school have yet to be answered, school nurses are sometimes considered as useless, with school healthcare suffering as a result. This essay first examines the development of professional school nursing in order to demonstrate the import role played by nurses in schools. Critical problems identified by the R.O.C.. School Nurses Association over the past decade in their work to secure school nurse rights and their solutions will be explained in order to underscore the contribution of school nurses and problems presently faced. Finally, the present dilemma and future direction of school nursing and nurses will be described.     

Nurse‐led intermediate care: an opportunity to develop enhanced roles for nurses?*

BACKGROUND: Nurse-led intermediate care units are being set up across the UK primarily as potential solutions to hospital bed crises. AIMS: This paper draws on data collected as part of a comprehensive evaluation of one 10-bedded nurse-led unit (NLU) located in the South of England. It explores the potential for enhanced nursing roles provided by such units by focusing on the views of NLU nursing staff and other professional groups within the Hospital Trust where the unit is located. METHODS: A total of 38 in-depth audio-taped qualitative interviews were conducted with NLU nursing staff and with a range of other professional groups (managers, acute ward nurses and doctors). FINDINGS: These data indicated that models of nurse-led postacute care do provide opportunities for nurses to develop enhanced nursing roles in which care associated with concepts of therapeutic nursing can be provided. However, even though the nurses derived satisfaction from their work on the NLU this model of care was seen by junior and middle grade nurses and other professional groups as being of low status. In contrast to senior nurses' views, they did not equate work on the NLU with the continuing professionalization of nursing. Senior nurses viewed the route to developing nursing on the NLU as involving nurses as doctor substitutes (extended roles) rather than as working in separate but complementary therapeutic domains (enhanced roles). CONCLUSIONS: NLUs provide opportunities for nurses to develop enhanced roles in which they can work autonomously in providing elements of therapeutic nursing aimed at improving patient outcomes at discharge. However, education, training and leadership will be needed to ensure that such opportunities are well understood and are optimized to the benefit of nurses and their patients.     

From clinical reasoning to ehealth interventions; a study on how nurses asses care and ehealth in home care

The assessment of care in homecare today is complex. Nurses have to decide on care for clients with multiple health problems. Technological innovations promise solutions for support of self-management of older people. We do not know, however, how and when nurses assess eHealth. A qualitative study design was used, in which 43 homecare nurses participated in focus groups and think aloud interviews. The study shows that nurses believe a trusting relationship necessary in order to suggest eHealth interventions. Nurses say they need home visits for the assessment of eHealth. Nurses also have some strong opinions on eHealth, like the notion that eHealth isn't a fitting option for frail older people. It becomes clear that nurses need to see eHealth interventions fit for clients in a person-centred way and in close connection to health problems they've prioritised in order to assess it. Implications for practice and further research are to focus on how nurses can be convinced to assess and use eHealth in a person-centred way and how to discuss this with their clients. Next to that training and a tool that provides up to date information linked to frequently seen health problems are recommended.     

Creating a Sensory-Friendly Pediatric Emergency Department

IntroductionFor children with autism spectrum disorder (ASD) and sensory-processing disorder (SPD), an unexpected visit to the emergency department can be an overwhelming experience that creates intensifying behaviors and an unsafe clinical interaction for the child, nurses, and providers. Although resources exist to help nurses work with this specialized group, there are limited examples of the challenges and opportunities of modifying an emergency department to be a place where nurses can provide sensory-informed care.MethodsGuided by Watson’s Theory of Caring, nurses and child life specialists in our pediatric emergency department initiated a practice improvement (PI) project to create a sensory-friendly emergency department. The nurses (1) engaged with community members and families, (2) examined current practices, (3) modified the patient care environment, (4) collaborated in an interprofessional educational session, and (5) created a shared vision for the modified patient-care environment.ResultsThis article describes the nurse-initiated PI process and the journey to create an evidence-based sensory-friendly pediatric emergency department. A model is presented so that other facilities can embark on their own initiative, and case studies are used to evaluate project outcomes.DiscussionIntegrating current evidence, staff suggestions, community input, and expert advice allowed us to find creative solutions to the unique sensory needs of children who visit our emergency department. Modifying both the patient-care environment and the patient-flow process to accommodate for the needs of children with ASD/SPD created a more peaceful and healing environment for children and their families and gave nurses the support they needed to provide sensory-informed care.     

Ethical issues and new nurses: preventing ethical distress in the work environment

As new nurses move from the familiar educational milieu into a work situation they encounter barriers to caring for patients and their families. The characteristics of the contemporary work environment, paired with the competencies of the new graduates, have the potential to threaten the ability of these nurses to provide safe and effective care for patients thus creating ethical distress. Educational interventions in the work place can effectively provide adequate solutions to these problems. The keystone between the healthcare institution and the development of a competent nurse is an effective mentor. As new nurses graduate from school and enter the health care industry they encounter many barriers that distract them from caring for their patients. With limited experience they are ill equipped to prevent ethical distress when confronted with ethical dilemmas. Educational strategies such as an adequate orientation can help a new graduate cope with the complexities of a health care industry confronted by an increase in acuity of patients, progressively more complex medical interventions, and a shortage of nurses.     

Registered Nurses'' Perceptions of Their Communication with Spanish-Speaking Migrant Farmworkers in North Carolina: An Exploratory Study

Communication forms the foundation for all that nurses do. Recently, nurses working with migrant farmworkers have become challenged as the language of this population has become predominantly Spanish. To explore how nurses in North Carolina are managing communication issues, 55 nurses at 12 state health care agencies that serve migrant farmworkers was surveyed. Data were collected to determine what nurses believed about various communication issues involving these Spanish-speaking clients, including how they were presently communicating with them, in what areas of nursing functions they believed communication barriers were problematic, what they were doing to improve their communication, and what they envisioned the potential solutions were concerning communication barriers. Language differences proved to be substantial barriers to adequate nursing care for these individuals. Nurses cited many problems and said that they were receiving little assistance from their agencies to improve direct communication with the clients. Responses indicated a need for and a willingness by nurses to focus on improving communication with Spanish-speaking clients. Classes held at their agencies were seen as the most effective way of learning Spanish.     

Forensic psychiatric nursing: skills and competencies: II clinical aspects

This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non-forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty; (2) the skills best suited to overcome those problems; and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non-forensic psychiatric nurses and 43 other disciplines. The results highlighted a 'top ten' list of main problems with possible solutions and main areas for development. The conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.     

Interdisciplinary practice, education, and research: the expanding role of the occupational health nurse.

The nurses' roles are changing and expanding along with the changing health care system. Occupational health and environmental health nurses are in key positions to coordinate and direct interdisciplinary practice, education, and research. Occupational and environmental health nurses have a broad knowledge base in which they deal with employers, employees, stakeholders in communities, different governmental organizations, and families. Interdisciplinary collaboration is a way to find possible solutions to meet the needs of the work force, their families, communities, and the global community. Nurses must educate the different disciplines about their worth in collaborative interdisciplinary practice, education, and research. No single discipline can help individuals reach their full level of well-being. Interdisciplinary practice, education, and research should be encouraged for nurses to provide the best care for individuals in need of health care.     

高干病房护士惧怕否定心理调查分析

目的探求高干病房护士心理压力源及相关对策。方法应用惧怕否定评价量表(FNE)对高干病房护士(A组)和普通病房护士(B组)进行问卷调查。结果高干病房护士FNE得分显著高于普通病房护士得分,两者相比有显著性差异(P<0.05)。结论与普通病房护士相比,高干病房护士有非常明显的惧怕他人否定的心理倾向。     

Mid-career opportunity for nurses: learning and growing through a health policy internship

This article shares the experience and insight gained from a mid-career policy internship offered through the National Academy of Social Insurance. The author is a nursing doctoral student who interned on veterans' long-term care projects with the Health Care Team at the Government Accountability Office in Washington, D.C. As the average age of nurses continues to rise and society faces nursing shortages, new opportunities and solutions must be considered to keep aging nurses in the workforce. A mid-career internship is a very real option that will benefit health policy organizations, the nursing community, and aging nurses.     

儿科内科门诊护士心理健康状况调查分析与对策

目的 了解儿科内科门诊护士心理健康状况,针对性地给予应对措施,进一步的提高儿科内科门诊护士的心理健康水平.方法 采用基本情况调查表与症状自评量表(SCL-90)对55名儿科内科门诊护士进行问卷调查,将问卷调查结果进行数据的统计分析.结果 儿科内科门诊护士的心理健康水平低于普通人群,从SCL-90得分情况分析,其躯体化、强迫、抑郁、焦虑、敌对、恐惧、精神病性、总均分和阳性项目数等9项因子均分明显高于常模(P<0.05);62%～82%感觉多种不适应的心理症状,以躯体障碍、强迫、抑郁、焦虑和敌对最突出.结论应采取相应的对策,缓解门诊工作压力,提高儿科内科门诊护士自身的心理调节能力,促进身心的健康发展,更好地为儿童提供健康服务.     

Bridging the generation gap.

Generational differences will always exist among nurses and patients. However, with our limited resources, the aging of our patient population, and increased longevity, it is pivotal that we identify effective strategies to transcend generational differences that may compromise patient care. By joining forces, we can maximize our knowledge and skills and in the process enhance our ability to value the contribution of these generational differences to improve quality nursing care and rehabilitation practice. Although the solutions may not be simple, we must persist in discovering creative solutions to overcome the multiple conflicts emerging from patient and nursing generational differences.     

Health policy and legislation: impact on cancer nursing and care

OBJECTIVES: To review policy and legislative initiatives in which nursing has played roles and to provide insight into trends and issues that characterize the policy and political agendas in which oncology nurses can play advocacy roles in the new millennium. DATA SOURCES: Professional journals, books, newspapers, news magazines, and internet web sites. CONCLUSIONS: Oncology nurses can offer solutions to the dilemmas posed by fiscal realities, unique American values and expectations, and the complexities of cancer care in the United State's market-based health care system. Oncology nurses must assume roles as health policy specialists. IMPLICATIONS FOR NURSING PRACTICE: For nurses to gain acceptance in health policy arenas, individual nurses and groups of nurses must become expert in assessing the environment, the interpretation of cues, and the development and implementation of realistic strategies targeting priority health policy and legislative issues.     

Can nurses rise to the public health challenge? How a novel solution in nurse education can address this contemporary question

This paper raises the problem of how improvements in health outcomes, a key component in many governments' strategies, can be achieved. The work highlights a novel undergraduate educational approach which offers solutions to public health challenges within nursing. Against the backdrop of one UK university institution it discusses approaches that can guide nursing students towards a deeper understanding and engagement within the principles of public health. It then proposes how nurses can use their learning to become leaders of health improvement.