Assuring competence or ensuring performance

Nurses' learning about professional interpersonal communication: Findings from an integrative review

BACKGROUND

Effective communication, a cognitive and social skill, is pivotal in quality care delivery. It is important to explore how nurses learn about communication during their program of study, and more importantly the substance of what they have learnt regarding communicating with patients. This is of value given the changing context of health care, society and contemporary nursing.

AIM

To explore learning and teaching practices of professional, interpersonal communication and the associated outcomes for student learning during pre-registration education.

DESIGN

Integrative review.

DATA SOURCES

Four databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Proquest and Scopus, were searched January 2000 through to December 2020. A subsequent rapid review of literature 2020 to 2023 was guided by Dobbin's method.

REVIEW METHOD

Whittemore and Knafl's framework guided this review. It included 1. problem identification, 2. literature search, 3. data evaluation, 4. data analysis, and 5.

PRESENTATION

The PRISMA protocol informed screening of literature. The quality of included articles was assessed using the Mixed Method Appraisal Tool (MMAT).

RESULTS

Of the initial eligible 46 articles critiqued, 26 remained; A rapid review found one further article. Twenty-seven articles were included in the final analysis. We derived a comprehensive understanding of curricula that included conceptual approaches, teaching techniques, student outcomes, and novel innovations. Conceptional approaches described self-efficacy based on Bandura's social learning theory. Teaching techniques to advance social and active learning though varied, were dominantly active experiential learning. Student outcomes were forthcoming across all described modes of learning and teaching that involved good education practices that actively engaged learners. Finally, we specifically identified novel practices that included immersion, repetition of deliberate practice, scaffolding and coaching. The specific unique contribution of these practices was the capacity to acknowledge and embrace existing innate student capacities.

CONCLUSION

Current literature advocates students learning of professional communication is forthcoming from appropriately designed courses. Research and evaluation of student learning remains rudimentary. The contribution of factors such as students' life skills and innate communication ability to their learning of professional interpersonal communication is largely absent. Further research is needed regarding the best focus for learning and teaching of professional interpersonal communication.

Nurses' Perceptions of the Relevance of Their Role and Responsibilities for Adopting Evidence-Based Feedback Into Practice: An Implementation Study

AIMS

To evaluate the implementation process of a novel program focused on improving interactive (dialogic) feedback between clinicians and students during placement.

DESIGN

Quantitative cross-sectional hybrid type 3 effectiveness-implementation study driven by a federated model of social learning theory and implementation theory.

METHODS

From June to November 2018, feedback approaches supported by socio-constructive learning theory and Normalisation Process Theory were enacted in four clinical units of a healthcare facility in southeast Queensland, Australia. The study involved 16 clinical instructors/supervisors, 94 bedside nurses, and 85 final-year nursing students. Engagement was evaluated using the Normalisation Measure Development survey. Situated learning encounters were constructed based on the needs of each group.

RESULTS

Survey results of the four Normalisation Process Theory constructs identified variable adoption by participant groups. Engagement in situated learning encounters that facilitate dialogic feedback was greatest in clinical instructors/supervisors, followed by students. Bedside registered nurses, while indicating they understood purposeful feedback behaviours, did not demonstrate them in practice.

CONCLUSION

The extent to which each group practiced dialogic feedback depended on their perceptions of their influence, whether they saw it as part of their role, and the effort and time required, regardless of the activity's importance, role statements, and codes of conduct.

IMPLICATIONS FOR THE PROFESSION

Understanding the norms that shape communication, engagement, and nurses' role priorities is crucial for guiding practice and ongoing engagement with feedback.

IMPACT

The research provides valuable insights for leaders aiming to enhance the integration of evidence into practice. It guides leaders to understand that participants prioritise the reach, relevance, and resources of evidence over formal role descriptions, responsibilities, policies, and codes of conduct. This research encourages leaders to scrutinise existing beliefs, norms, and routines when implementing evidence-based practices.

REPORTING METHOD

Standards for Reporting Implementation Studies (StaRI) reporting guidelines were used.

NO PATIENT OR PUBLIC CONTRIBUTION

None.

Evaluating a competency framework for rheumatology nurses

The Royal College of Nursing (RCN) competency framework for rheumatology nurses was developed in 2020. As part of the framework proposal, a service evaluation was planned following the framework's roll-out to determine its usefulness and acceptability. The aim of this evaluation was to explore rheumatology nurse specialists' answers to the research question: 'What was your experience of using the RCN's rheumatology competency framework?' A total of 14 rheumatology nurse specialists were interviewed and shared their opinions regarding the competency framework. Five themes were identified: personal usage; benefits to managers; inequalities and inequity in nursing; ideas for improvement; and general properties. The findings of this evaluation demonstrated the value of the framework, which enabled rheumatology nurse specialists to document the competency level they were working at and to identify their future training needs.

Competency versus proficiency: trying to develop an understanding of these terms in the context of practice learning

The language of nurse education in the UK has shifted from 'competency' to 'proficiency' since 2018. The shift in language has been poorly articulated leaving individual higher education institutions, practice supervisors and assessors to interpret what these terms mean in relation to assessing student nurses. There appeared to be some confusion regarding the interpretation of the term proficiency among those who engaged in an exchange on the topic via Twitter. Students may focus on the procedure-based checklists within the standards. The relationship between proficiency and implementing a person-centred approach to care remains unclear.

Developing a model for predicting safety performance of nurses based on psychosocial safety climate and role of job demands and resources, job satisfaction, and emotional exhaustion as mediators

BACKGROUND

The present study aimed to develop a model for predicting the safety performance of nurses based on psychosocial safety climate (PSC) and the role of job demands and resources, job satisfaction, and emotional exhaustion as mediators.

METHODS

A cross-sectional study using structural equation modeling (SEM) was carried out among nurses in Iran. Data were collected using the Psychosocial Safety Climate questionnaire, Neal and Griffin's Safety Performance Scale, the Management Standards Indicator Tool, the Effort-Reward Imbalance questionnaire, the Michigan Organizational Assessment Job Satisfaction subscale and the Maslach Burnout Inventory.

RESULTS

Surveys were distributed to 340 nurses provided informed consent. After removing incplete surveys, data from 280 partipants were analysed. The completion rate was 82.35%. The SEM results indicated that PSC can directly and indirectly predict nurses' safety performance. The final model showed an acceptable goodness of fit (p = 0.023). It indicated that PSC, job demands, and job satisfaction were directly related to safety performance, and also that PSC, emotional exhaustion, job resources, and job demands were all indirectly related to safety performance. Also, PSC had a significant relationship with all mediator variables, and job demands had direct effect on emotional exhaustion.

CONCLUSIONS

The current study presented a new model for predicting safety performance in nurses in which PSC, both directly and indirectly, plays an important role. In addition to paying attention to the physical aspects of the workplace, healthcare organizations should also take into account PSC to improve safety. Next steps in reducing safety issues in nursing is to develop intervention studies using this new evidence-based model as a framework.

Validity and Reliability of the Korean Version of the Holistic Nursing Competence Scale

This methodological study aimed to verify the validity and reliability of the Korean version of the Holistic Nursing Competence Scale (HNCS), which comprises five dimensions and 36 items. The English version of the HNCS was forward and backward translated and administered to 251 participants with more than a year of work experience in a general hospital. Data were analyzed using SPSS WIN 24.0(Chicago, IL, USA), and AMOS program was used for confirmatory factor analysis. Additionally, the “Task Performance Evaluation Instrument for Clinical Nurses” was used for concurrent validity. Reliability assessed using Cronbach’s α was 0.969. Convergent, discriminant, and concurrent validity were good. Average variance extracted and construct reliability ranged from 0.845 to 0.932 and 0.980 to 0.987, respectively. The model was suitable with the chi-square value being 1216.563 (df = 584, p < 0.001), and Q value being less than three. Goodness-of-fit index, root mean square residual, and root mean square error of approximation were 0.784, 0.066, and 0.066, respectively. Moreover, comparative fit index, Tucker−Lewis index, and incremental fit index were 0.913, 0.906, and 0.913, respectively. Thus, this study verified the validity and reliability of the Korean version of the HNCS. Our findings suggest that the scale is helpful in measuring and developing the holistic nursing competence of clinical nurses.

Strategies to Implement a Competency Assessment Verification Program

Professional role competence is an essential element of nursing practice and an integral component of providing safe perioperative patient care. In the health care setting, verifying professional role competence and managing the associated documentation can be complex. Educators can use a variety of modalities (eg, flipped classrooms, gaming, podcasts) to present information in a manner that supports adult learning principles. When developing a competency assessment verification program, perioperative leaders should use a structured model to provide consistency; they also should partner with staff members and other key stakeholders (eg, surgeons, risk management personnel) to identify and prioritize ongoing competencies. The leaders and educators should identify competency verification methods, and leaders should designate qualified observers if needed. Documentation of competency activities should be stored in an easily accessible location. Implementing a standardized competency assessment verification program is a best practice that should result in improved patient outcomes.

Advancing Excellence in Community Health Nursing Through Evidence-Based National Standards of Practice

BACKGROUND

Current standards of practice are necessary to ensure safe nursing practice in Canada and across the world. This article aimed to describe and present findings from the rigorous review process undertaken to update the 2011 Canadian Community Health Nursing Standards of Practice.

METHOD

A revision process included a scoping review of the literature, focus groups, and a modified Delphi method.

RESULTS

Through the inclusive consultation process, 495 community health nurses enhanced the content of the standards with respect to cultural safety, cultural humility, Indigenous health and ways of knowing, health equity, and evidence-informed practice.

CONCLUSION

This comprehensive revision process can guide other nursing specialty groups developing or revising specialized practice standards in Canada and across the world. [J Contin Educ Nurs. 2021;52(4):168-175.].

The Frontline Nurse's Experience of Nursing Outlier Patients

The frontline nurses' experience of nursing with overstretched resources in acute care setting can affect their health and well-being. Little is known about the experience of registered nurses faced with the care of a patient outside their area of expertise. The aim of this paper is to explore the phenomenon of nursing the outlier patient, when patients are nursed in a ward that is not specifically developed to deal with the major clinical diagnosis involved (e.g., renal patient in gynecology ward). Using a hermeneutic phenomenological approach, eleven individual face-to-face in-depth interviews were conducted with registered nurses in New South Wales, Australia. The study identified that each nurse had a specialty construct developed from nursing in a specialized environment. Each nurse had normalized the experience of specialty nursing and had developed a way of thinking and practicing theorized as a "care ladder". By grouping and analyzing various "care ladders" together, the nursing capacities common to nurses formed the phenomenological orientation, namely "the composite care ladder". Compared to nursing specialty-appropriate patients, nursing the outlier patient caused disruption of the care ladder, with some nurses becoming less capable as they were nursing the outlier patient. Nursing the outlier patient disrupted the nurses' normalized constructs of nursing. This study suggests that nursing patients in specialty-appropriate wards will improve patient outcomes and reduce impacts on the nurses' morale.