Admiral nursing competency project: practice development and action research

Aims and background. Admiral Nurses are specialist dementia care nurses working in the community with carers of those who have a dementia. The aim of the competency project (2000–2003) was threefold. Firstly to work collaboratively with these specialist nurses to facilitate the development a competency framework that reflects the needs of the Admiral Nursing Service. Secondly, to provide a way to structure evidence demonstrating evolving competency. Thirdly, to specifically enable the nurses to demonstrate evidence of achieving the UK Nursing and Midwifery Council's Higher Level Practice standard. Design and methods. The two complementary approaches of emancipatory action research and systematic practice development were adopted. Methods were taken from action research and systematic practice development approaches with an emphasis on promoting and enabling enlightenment, critical reflection, ownership and creating the best conditions for long‐term commitment to the competency framework. Results. The main outcome from this project was the development of a specialist nursing competency framework. The Admiral Nurses’ Competency Framework is made up of a set of eight core competencies with three levels of competency statements, loosely structured around the Higher Level Practice standard, and guidance documentation to illustrate how work‐based evidence can be generated to demonstrate competence. There were also process‐derived outcomes associated with combining systematic practice development with emancipatory action research that had an impact on the culture. The main outcomes here were that practitioners engaged in and experienced learning about how to research their own practice and the consequences of doing this. They also learnt about specialist nursing practice more widely than Admiral Nursing. Finally, there was some increase in awareness about the culture within their teams and organizations. The final competency framework reflects the needs of the service, is owned by the majority of practitioners and project commissioners and this has had a positive impact on implementation. Conclusion. In this paper, we report on combining systematic practice development with action research to achieve immediate project aims. In addition we show how a project of this nature can contribute to developing skills in practitioners necessary for cultural changes in practice and contributes to wider issues of modernization within nursing and health care. Relevance to clinical practice. This competency framework will enable Admiral Nurses to demonstrate their level of specialist practice, as individuals and collectively as a service and it also promotes the principles of nurses as life long learners. This may have relevance to other groups of specialist nurses. The project has widespread relevance for two reasons. Firstly, it shows that nurses can be involved in designing and testing a competency framework as collaborators. Secondly, that to achieve this within the spirit of approaches, such as systematic practice development and action research, can be testing for all collaborators even were there is a shared or espoused aim.     

A competency framework for orthopaedic and trauma nursing

Competency frameworks are an increasingly common method of driving forward practice quality and meeting the demand for job evaluation and professional development. This paper describes a project supported by the United Kingdom (UK) Royal College of Nursing Society of Orthopaedic and Trauma Nursing to develop a competency framework for orthopaedic and trauma nursing. It describes the process employed in the development of the framework, the results of consultation with UK orthopaedic and trauma nurses and the final competency statements. The framework is of relevance to all orthopaedic and trauma nurses who need to work with their employers to identify how the statements can be translated into practice outcomes. There are implications for orthopaedic and trauma nursing education.     

Cardiac nursing: achieving competent practitioners.

This paper describes how competency statements were integrated into an academic framework to provide a transparent yet flexible career pathway for the nurse working in acute cardiac care. Nurses are expanding and developing their roles and use wide ranging skills and knowledge to care for patients. Additionally, models of care delivery are changing and patients are cared for in a variety of settings. Where evidence exists, these models demonstrate improvement in the provision and quality of services and contribute to improved quality of life, maximise medication and therapy and reduce waiting times for investigations. However, whilst many studies have demonstrated benefit, translating these results into routine practice requires skilled nurses who are "fit for purpose," and to support this, professional competencies can be used to measure competence in practice whilst informing educational initiatives. This paper outlines the development of competency statements that identify the knowledge and skills required for safe, effective and competent care and direct the cardiac nurse acquire skills and knowledge in a focused and coherent way.     

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.     

A necessity not a luxury: preparing advanced practice nurses to care for older adults.

Of today's 2.7 million registered nurses, less than 1% are certified in gerontological nursing and only 3% of advanced practice nurses (APNs) have specialized training in this area. These statistics indicate that there are not enough gerontological nurse practitioners or geriatric clinical nurse specialists to care for the burgeoning older adult population. Relying solely on certified geriatric APNs to care for older adults is not a viable solution. Educating all APNs with grounding in gerontological nursing care may well be the answer to expanding our nation's capacity to competently care for our rapidly aging population. As part of the 4-year Enhancing Geriatric Nursing Education in Baccalaureate and Advanced Practice Nursing Grant, the American Association of Colleges of Nursing developed a set of core gerontological competencies for graduate APN programs. These competencies, entitled Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care, delineate guidelines for APNs who are not specialists in gerontology but provide care to older adults. This article describes the competency development process, provides an overview of broad categories and examples of competency statements, and highlights model case studies for integrating gerontological content throughout APN curricula to ensure that graduates are equipped to provide competent care to older adults.     

Development of an international interdisciplinary course: A strategy to promote cultural competence and collaboration

Now, more than ever, nurses are practicing in settings in which cultural competence and teamwork are essential to providing quality care. The expectation that nurses provide effective care across varied population groups highlights the need for attainment of cultural competency by baccalaureate nursing graduates. Nursing programs must develop strategies to address this educational need. In this article, the authors share their experiences in the development of an international interdisciplinary course that combined academic service learning with cultural immersion to promote the development of cultural competence and collaboration among students. By developing an interdisciplinary course that is of interest to a wide range of students, faculty can be successful in providing an opportunity for students with varied career paths to be better prepared to live and work in the world's global community.     

内分泌科护士糖尿病护理胜任力现状及影响因素分析

目的了解内分泌科护士糖尿病护理胜任力水平现状,分析其影响因素。方法采用便利抽样法抽取山东省5所地级市三级医院的140g内分泌科护士进行问卷调查。结果内分泌科护士糖尿病护理胜任力总分为（4．25±0．51）分,其中法律意识（4．42±0．59）分,人际关系、沟通能力（4．30±0．54）分,临床护理能力（4．28±0．53）分,领导能力（4．19±0．58）分,专业发展、科研能力（4．06±0．57）;专业兴趣和职称是护理胜任力的影响因素,共解释护理胜任力总变异量的21．7％。结论护理管理者可以尝试通过提高护士专业兴趣提高其专业胜任力,要加强内分泌科低职称护士胜任力的培养。     

The development of competency standards for specialist critical care nurses

In defining the contemporary role of the specialist nurse it is necessary to challenge the concept of nursing as merely a combination of skills and knowledge. Nursing must be demonstrated and defined in the context of client care and include the broader notions of professional development and competence. This qualitative study sought to identify the competency standards for nurse specialists in critical care and to articulate the differences between entry-to-practice standards and the advanced practice of specialist nurses. Over 800 hours of specialist critical care nursing practice were observed and grouped into 'domains' or major themes of specialist practice using a constant comparison qualitative technique. These domains were further refined to describe attributes of the registered nurses which resulted in effective and/or superior performance (competency standards) and to provide examples of performance (performance criteria) which met the defined standard. Constant comparison of the emerging domains, competency standards and performance criteria to observations of specialist critical care practice, ensured the results provided a true reflection of the specialist nursing role. Data analysis resulted in 20 competency standards grouped into six domains: professional practice, reflective practice, enabling, clinical problem solving, teamwork, and leadership. Each of these domains is comprised of between two and seven competency standards. Each standard is further divided into component parts or 'elements' and the elements are illustrated with performance criteria. The competency standards are currently being used in several Australian critical care educational programmes and are the foundation for an emerging critical care credentialling process. They have been viewed with interest by a variety of non-critical care specialty groups and may form a common precursor from which further specialist nursing practice assessment will evolve.     

Exploring haematology nurses' perceptions of specialist education's contribution to care delivery and the development of expertise

The role that educational preparation may play in the delivery of care and the development of expertise is a point of some debate [Manley, K., Garbett, R., 2000. Paying Peter and Paul reconciling concepts of expertise with competency for a clinical career structure. Journal of Clinical Nursing 9 (3), 347; King, L., Macleod Clark, J., 2002. Intuition and the development of expertise in surgical ward and intensive care nurses. Journal of Advanced Nursing 37(4), 322-329; Bonner, A., 2003. Recognition of expertise: an important concept in the acquisition of nephrology nursing expertise. Nursing & Health Sciences Journal 5, 123-131; Dunphy, B.C., Williamson, S.L., 2004. In pursuit of expertise. Advances in Health Sciences Education 9, 107-127]. Though education is a concept that may be universally valued, it may be more difficult to clearly discern the significance it has for practitioners who are developing their expertise. This research project employed an interpretive phenomenological design to explore the perceptions of specialist haematology nursing staff on the extent to which specialist education contributes to care delivery and the development of expert practice. A non-representative purposive sample of qualified nurses who had undertaken specialist education in haemopoiesis and work in specialist haematology participated in a focus group and semi-structured interviews. The report concludes that, for these specialist practitioners, specialist educational input had a beneficial impact on their levels of knowledge and confidence. Further to this, involvement in higher education had enabled them to become more active in the learning process. Perhaps the key finding of the study was the assertion by respondents that specialist educational input had enabled them to develop their specialist practice to a level that experience alone could not achieve.     

Developing children’s nursing care outcome statements in Africa using World Café methods

Nursing metrics use indicators to make the outcomes of nursing care visible through measurement. Metrics must be sensitive to the context-specific nature of nursing and should reflect the work that nurses really do. A workshop at the Building Children’s Nursing conference (2019) was convened to develop statements of nursing care outcomes and actions specific to the work of children’s nurses in African care settings, using the World Café method and the Nightingale Metrics approach. The process resulted in the development of statements as intended. Appropriate nursing metrics can guide data-driven practice improvements and decision-making about supporting the nursing workforce.     

Is nursing profession my first choice? A follow up survey in pre-registeration student nurses

The purpose of this study was to explore how nursing students' value factors, motivational factors, institutional factors and competence factors contributed to career intent. All fifth-year nursing students (n=231) in a college in eastern Taiwan completed a survey which followed-up a study done 1 year previously in the same population were followed for 1 year. A validated and reliable self-administered questionnaire developed by the investigators in 2004 and modified in 2005 was used in the study. Data on value factors, competence factors, motivational factors, and situational factors were collected. The overall response rate was 87.4%. The rates of considering nursing as their first choice improved from 19.1% at the point of college-entry to 34.6% in 2004 and 46.5% in 2005 in the same cohort students. Past experience with being ill, degree of stress, self-rated clinical competency, perceived support from staff nurses, and perceived value were associated with career decision after the completion of a whole year of clinical practice (p<0.05-0.01). In multivariate analysis, perceived support from staff nurses, past experience with being ill, and perceived value proved to be significant predictors of the career intent of pre-registration student nurses. Nursing faculty and nurse administrators need to provide assistance to reduce nursing students' career attrition.     

Testing the model for testing competency

The pilot study to demonstrate the utility of the CBRDM in the practice setting was successful. Using a matrix evaluation tool based on the model's competencies, evaluators were able to observe specific performance behaviors of senior nursing students and new graduates at either the novice or competent levels. The study faced the usual perils of pilot studies, including small sample size, a limited number of items from the total CBRDM, restricted financial resources, inexperienced researchers, unexpected barriers, and untested evaluation tools. It was understood from the beginning of the study that the research would be based on a program evaluation model, analyzing both processes and outcomes. However, the meager data findings led to the desire to continue to study use of the model for practice setting job expectations, career planning for nurses, and curriculum development for educators. Although the California Strategic Planning Committee for Nursing no longer has funding, we hope that others interested in role differentiation issues will take the results of this study and test the model in other practice settings. Its ability to measure higher levels of competency as well as novice and competent should be studied, i.e., proficient, expert, and advanced practice. The CBRDM may be useful in evaluating student and nurse performance, defining role expectations, and identifying the preparation necessary for the roles. The initial findings related to the two functions as leader and teacher in the care provider and care coordinator roles led to much discussion about helping students and nurses develop competence. Additional discussion focused on the roles as they apply to settings such as critical care or primary health care. The model is useful for all of nursing as it continues to define its levels of practice and their relationship to on-the-job performance, curriculum development, and career planning.     

The professional nurse and regulation.

The regulation of nursing began as a simple registry process to protect the nursing title and the public. Today, the primary purpose is still the protection of the public through defining nursing practice, approving nursing education, and overseeing the competence of nurses through licensing and disciplinary rules and regulations. State Boards of Nursing are legislatively given the authority to license and discipline the nursing profession. The RN is responsible for the care given to assigned patients. Issues of staffing, delegation, and reporting of incompetent or impaired nurses are a concern of nurses today with regard to their license. Each nurse must understand the regulations, which vary from state to state, that directly and indirectly affect his/her daily practice. As the health care environment is met with several challenges, pressures are increasing to modernize the licensing and competency assessment of nurses. Ultimately, the safety of patients must remain at the center of the regulatory debate.     

South African neonatal nurse specialization – is professional licensing justifiable?

Neonatal nursing is currently not acknowledged as a clinical nurse specialization in the South African context. It is argued that neonatal nursing meets all criteria for designating nursing specialists as specified by the International Council of Nursing. A competency framework is proposed aligned with the country's qualification framework. Acknowledgement of neonatal nurses as clinical nurse specialists is expected to influence policy in education and clinical practice that in turn will influence neonatal care practices and outcomes for preterm and critically ill neonates and their families.     

我国三级医院护士执业环境的现况研究

目的了解我国三级医院护士执业环境现状及存在问题。方法依托国家护理质量数据平台,应用护士执业环境测评量表对我国629所三级医院的护士进行调查和分析。结果护士执业环境测评总均分为(78.74±6.22)分,对新入职护士的培训、为患者提供良好护理服务、对护士长认可、职业暴露后的处理、胜任护理工作等几个方面认可度较高;得分较低的条目主要涉及护士参与管理决策、专业及个人发展机会、薪酬待遇、社会地位方面;不同特征护士的执业环境得分存在差异,其中男性、本科及以上学历、护师和主管护师、年龄30~39岁、职务为护士、工作年限5~9年的护士执业环境得分较低(P0.01)。结论我国护士执业环境的改善应关注护士医院管理参与度、薪酬待遇、职业发展、不同人群的需求等,充分调动护士工作的积极性,提升临床护理质量。     

Implementing competency recommendations into pre-registration nursing curricula: effects upon levels of confidence in clinical skills

The competency based pre-registration nursing curriculum was introduced to address concerns about levels of confidence and competence in skills of newly qualified Project 2000 educated nurses [Department of Health, 1999. Making a Difference: Strengthening the Nursing, Midwifery and Health Visiting Contribution to Health and Healthcare. The Stationary Office, London]. This study sought to examine whether the implementation of the competency recommendations has led to improvements in the confidence of nursing students in their clinical skills. A self-administered questionnaire examining ratings of confidence in areas of nursing practice and core competencies as specified by the Nursing and Midwifery Council (NMC) [UKCC, 2001. Requirements for Pre-registration Nursing Programmes. UKCC, London] was administered to 139 final year adult nursing students who were studying with the Project 2000 or competency curriculum. The response rate was 53%, results indicating that the students studying the competency curriculum have higher levels of confidence in all areas of their practice targeted by the competency recommendations than students studying in the Project 2000 curriculum. The positive effect that the competency recommendations had upon levels of confidence in nursing practice, and the implications of such changes to curricula are discussed.     

重症监护室护士共情能力与胜任力的相关性研究

目的了解重症监护室(intensive care unit,ICU)护士胜任力与共情能力的现状及其相关性。方法 2015年1-3月,便利抽样法选取哈尔滨市4所三级甲等医院的200名在ICU工作的护士为研究对象,采用一般资料调查表、中文版杰弗逊共情量表和ICU护士胜任力量表对其进行调查。结果 ICU护士共情能力得分为(109.69±10.54)分,胜任力得分为(189.79±21.73)分。ICU护士共情能力总分及3个分量表得分(情感护理、观点采择、换位思考)均与胜任力总分呈正相关(P0.05或P0.01)。结论 ICU护理管理者应注重护士共情能力的培养,提高护士的工作胜任力,从而提高ICU护理工作质量。     

The ABCs of the Doctor of Nursing Practice: Assessing Resources,Building a Culture of Clinical Scholarship,Curricular Models

The Doctor of Nursing Practice (DNP) degree prepares nurses to provide comprehensive care across sites and over time. It is absolutely crucial–for both patient care and the nursing profession–that broadly recognized standards of competency for these new practitioners be established. The Council for the Advancement of Comprehensive Care has met since 2000 to build consensus on competency standards and a process for certifying these graduates. Deans of five nursing schools discuss their experiences and provide guidance for schools interested in developing DNP programs.