Entry-to-practice public health nursing competencies: A Delphi method and knowledge translation strategy

Advancing home health nursing competencies in Canada to reflect a dynamic care environment and complex population health needs: a modified eDelphi study

BACKGROUND

Home health nursing competencies outline the knowledge, skills and attributes home health nurses need for safe and ethical practice. Since the Canadian Home Health Nursing Competencies were first developed in 2010, several important contextual changes have occurred. To ensure competencies reflect current practice contexts, this study aimed to update Canada's home health nursing competencies.

METHODS

A four-phase modified eDelphi study was conducted using online surveys, consensus meetings and feedback forms. An environmental scan was conducted to identify home health competencies emerging since 2010, to create a comprehensive set of preexisting competencies to serve as the starting point for a 3-round modified eDelphi process. The eDelphi was conducted with a panel of home health nurses (n = 43) to identify core competencies relevant to current home health nursing practice environments. Broader consultations with home health nurses (n = 41) and interdisciplinary home care team members (n = 12) were held to validate eDelphi findings. An advisory working group (n = 24) of home health nursing leaders provided guidance on study decision-making and final recommendations.

RESULTS

Three hundred fifty-nine preexisting competencies were consolidated into 96 unique home health nursing competencies. In Round 1 of the eDelphi, home health nurses reached consensus (agreement ≥ 75%) that 94 competencies were relevant to current practice environments and suggested five new competencies. Subsequent eDelphi rounds resulted in 93 competencies being brought forward as both relevant and essential for current home health nursing practice. Further consultations refined recommendations, resulting in a final set of 79 competencies. Qualitative feedback provided insights into the relevance and importance of competencies, opportunities for comprehension improvements, and implementation considerations.

CONCLUSIONS

The home health nursing competency set generated through this study incorporates core concepts in home health nursing practice, such as evidence-informed practice and interdisciplinary collaboration, along with several new concepts, such as trauma-informed care, data-driven decision-making, and provision of culturally safe care. This updated competency set can be used to inform prelicensure education and professional development opportunities to enhance home health workforce capacity. Future work exploring strategies to support competency uptake in education and home and community care organizations is needed.

Bachelor nursing competencies to care for children in hospital and home settings: A Delphi study

BACKGROUND

Caring for children from birth to adulthood requires extensive knowledge and skills specific to that population. In Switzerland, bachelor's nursing degree programs focus primarily on generalist competencies and may be insufficient for registered nurses to provide appropriate and safe care to sick children and their families.

OBJECTIVE

This study aimed to identify the competencies required for generalist nurses to care for children and their families in hospital and home-care settings.

DESIGN

A multicentered descriptive study was used.

PARTICIPANTS

Registered nurses' experts in their respective pediatric field were recruited via a regional network for pediatric nursing education in the French and Italian speaking part of Switzerland.

METHODS

A 3-round Delphi e-survey was used to develop a list of competencies.

RESULTS

Round 1 consisted of mapping 23 competencies clustered in seven domains, from four competency models by a panel of eight experts. Consensus was reached in Round 2 and 3, by 129 and 132 participants, respectively. After Round 3, all 23 competencies were rated expected or very much expected. The seven domains of competencies identified as most important were "Advocacy and Moral Agency" (cum. mean: 4,5), "Diversity Families Responsiveness" (cum. mean: 4,5), Collaboration (cum. mean: 4,4), Caring Practices (cum. mean: 4,4), Clinical Judgment and Inquiry (cum. mean: 4,4), Facilitating Learning (cum. mean: 4,3) and System Thinking (cum. mean: 4,2).

CONCLUSION

The comprehensive list of 23 competencies for nurses to care for sick children and their families in hospital and community settings, provides a solid base to review and benchmark existing nursing under-graduate program in Switzerland and beyond.

Mapping Public Health Nursing competencies: A comparative document analysis of competency frameworks and practice standards in the USA and Ireland

The Public Health Nursing discipline plays a crucial role in promoting sustainable health services. The establishment of competency frameworks and practice standards pertaining to Public Health Nursing has emerged as a cornerstone for guiding practice, education, and research. This study aimed to identify contemporary Public Health Nursing competency frameworks and practice standards and establish a robust list of competency domains. This will inform a subsequent phase of this project that will conduct a review of recent scholarly literature to discern prevailing research trends and delineate strategic directives and research priorities for the discipline. A systematic search of three databases and a grey literature search was undertaken by incorporating keywords to identify existing Public Health Nursing-specific competency frameworks and practice standards. Through screening and selection based on our inclusion criteria, three documents were analyzed. A comprehensive document analysis was conducted to generate a unified domain list and associated descriptors. Three competency-based frameworks and practice standards emanating from two countries, the United States of America and the Republic of Ireland met the inclusion criteria. The document analysis identified 16 individual domains. There was consistent evidence of similarity across the three documents. There were minimal divergences featured within the frameworks which are discussed and compelling justifications for inclusion as universal domains are provided. This document analysis has generated a list of 16 common Public Health Nursing competency domains which will be utilized in phase two of this project as a foundational framework for the purpose of analyzing research trends, influencing research priorities, and enhancing the focal areas for future research agendas within the discipline.

Essential core competencies for health policy graduates: a multi-method consensus type study

BACKGROUND

In light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.

METHODS

The study was conducted in three phases: a scoping review, qualitative interviews and the validation of identified competencies through brainstorming with experts. In the initial phase, a scoping review was conducted on the databases. The following databases were searched: PubMed, Scopus, Web of Science and Google Scholar search engine. Additionally, the WebPages of universities offering health policy programmes were manually searched. In the second phase, 36 semi-structured interviews were conducted with students, graduates and distinguished academics from Iran and other countries. These interviews were conducted in person or via email. In the third phase, the draft version of the competencies and their associated learning objectives, derived from the preceding stages, was subjected to independent review by an expert panel and subsequently discussed. In light of the expert panel's findings, the authors undertook a subsequent revision of the list, leading to the finalization of the core competencies through a process of consensus.

RESULTS

In the scoping review phase, the analysis included six studies and nine university curricula. The results of the scoping review could be classified into five domains: health system understanding, health policy research, knowledge translation, multidisciplinary work and knowledge of public health. In the second phase, six core competencies were extracted from the interviews and combined with the results of the first phase, which were then discussed by the expert panel at the third phase. The final five core competencies, derived from the brainstorming session and presented in no particular order, encompass health policy research, policy analysis, educational competencies, decision-making and multidisciplinary work.

CONCLUSIONS

It is essential that the curriculum is appropriate and contextually tailored, as this is crucial to foster multi-dimensional competencies that complement the specific disciplines of future health policy scholars. These scholars must possess the ability to genuinely serve their health systems towards achieving health-system goals and sustainable development.

Creating synergies among education/research, practice, and policy environments to build capacity for the scholar role in occupational therapy and physiotherapy in the Canadian context

Scholarly practice (SP) is considered a key competency of occupational therapy and physiotherapy. To date, the three sectors-education/research, practice, and policy/regulation-that support SP have been working relatively independently. The goals of this project were to (a) understand how representatives of the three sectors conceptualize SP; (b) define each sector's individual and collective roles in supporting SP; (c) identify factors influencing the enactment of SP and the specific needs of how best to support SP; and (d) co-develop goals and strategies to support SP across all sectors. We used interpretive description methodology. Consistent with an integrated knowledge translation approach, partners representing the three sectors across Canada recruited individuals from each sector, developed the content and questions for three focus groups, and collected and analyzed the data. Inspired by the Consolidated Framework for Implementation Research, we developed the questions for the second focus group. We analyzed the data using an inductive thematic analysis method. Thirty-nine participants from the three sectors participated. Themes related to participants' conceptualization of SP included (a) ongoing process, (b) reflective process, (c) broad concept, and (d) collective effort. Themes describing factors influencing and supporting SP were (a) recognition, (b) appropriate conceptualization, (c) social network, (d) accessibility to resources, and (e) forces outside of practitioners' effort. Goals to support SP included (a) further recognizing SP, (b) sustaining SP competency, and (c) ensuring access to information. SP requires collaborative and integrated intersectoral support and further recognition of its importance through the collaboration of multiple stakeholders.

Psychometric properties of a Chinese version of four-factor colorectal cancer screening belief scale

Objective

Screening improves the early diagnosis rate of colorectal cancer (CRC) and effectively reduces its mortality. The four-factor CRC screening belief scale is conducive to understanding the psychometric properties of screening beliefs, but no Chinese version of this scale is available. The purpose of this study was to test the psychometric properties of a Chinese version of the four-factor ​CRC ​screening belief scale in ​patients ​with cancer and their relatives.

Methods

The four-factor CRC screening belief scale was translated into Chinese based on Brislin's model. A panel review ensured the cultural adaptation and content validity of the scale. The scale was then administered to a convenience sample of 425 Chinese people recruited from July 2019 to June 2021.

Results

Exploratory factor analysis identified the factor structure for the Chinese version of the four-factor CRC screening belief scale, including perceived barriers, perceived benefits, self-efficacy, and optimism. Confirmatory factor analysis showed that the model fits well. The scale-level content validity index was 1.0. The correlation between the Chinese version of the four-factor CRC screening belief scale and the CRC health belief model scale was statistically significant (r = 0.831, P < 0.01). McDonald's omega coefficients for the entire scale were 0.939 and 0.774-0.948 for the four subscales. The translated scale had test-retest reliability of 0.719 and split-half reliability of 0.646.

Conclusions

The Chinese version of the four-factor CRC screening belief scale showed adequate reliability and validity. The translation and validation of psychosocial assessment tools for CRC screening across languages, cultures, and countries will contribute to further international research collaborations and the improvement of the prospects for the prevention and care of CRC.

Design a protocol to investigate the effects of climate change in vivo

Climate change has a variety of effects on communities and the environment, most of which have been directly addressed, such as floods, droughts, and fires. To date, the impacts of climate change on health in in vivo conditions have not been assessed, and no protocol has been developed in this regard. Therefore, the purpose of the current study is to develop a protocol as well as design and build a pilot to deal with climate change in vivo to show the direct effects of climate change on health. For this purpose, twenty specialists, comprising ten experts active in field climate and 10 experts in field medicine and anatomy, have been consulted to design the proposed exposure protocol using the Delphi method. According to the prepared protocol, an exposure pilot was then designed and built, which provides the climatic conditions for animal exposure with a fully automatic HMI-PLC system. The results showed the average 12:12-h day/night temperature, humidity, and circadian cycle for three consecutive ten-year periods selected for exposure of 1-month-old male rats. The duration of the exposure period is four months, which is equivalent to a ten-year climatic period. This study is a framework and a starting point for examining the effects of climate change on in vivo conditions that have not yet been considered.

Do and psychometric validation of the perinatal bereavement care competence scale for midwives

PURPOSE

To develop a scale for measuring the perinatal bereavement care competence of midwives and assess its psychometric properties.

METHODS

The Perinatal Bereavement Care Competence Scale (PBCCS) was developed in four phases. 1) Item generation: 75 items were formulated based on a literature review and interviews with midwives. 2) Delphi expert consultation: 15 experts evaluated whether the items were clear/appropriate/relevant to the questionnaire dimensions and the items were optimized. 3) Pilot test: the comprehensibility, acceptability, and time required to complete the questionnaire by midwives were assessed. 4) Evaluation of reliability and validity: the scale was validated by initial item analysis, exploratory and confirmatory factor analyses (EFA and CFA, respectively), and internal consistency reliability and test-retest reliability.

RESULTS

The final scale consisted of six dimensions and 25 items: Maintaining belief (3 items), Knowing (4 items), Being with (6 items), Preserving dignity (4 items), Enabling (5 items) and Self-adjustment (3 items). EFA yielded a 6-factor structure that was consistent with the theoretical framework and explained 70.87% of the total variance. CFA indicated a good fit for the 6-factor model. Cronbach's α for the scale was 0.931 and the test-retest reliability coefficient was 0.968.

CONCLUSION

The PBCCS is a valid and reliable instrument for measuring the competence of midwives in caring for bereaved parents who have experienced perinatal loss.

A Sisyphean task: Developing and revising public health nursing competencies

BACKGROUND

Competencies are intended to enhance the public health workforce's skills. Competencies used to evaluate public health nursing (PHN) practice and education have been promoted by several nursing organizations. Having multiple sets of competencies raises questions about redundancies and their usefulness in evaluating PHN, as well as the central question about the value of the competencies themselves.

METHODS

A literature review of psychometric evaluation research of the competencies was performed. Qualitative content analyses were conducted of seven documents: Association of Community Health Nursing Educators', 2000 and 2010 essentials; Quad Council Coalition's 2004, 2011, and 2018 competencies; and the American Nurses Association's, 2013 and the 2021 draft of PHN scope and standards of practice with respect to competency definition, conceptual basis, and use of an established taxonomy.

RESULTS

No psychometric evaluations of the competency sets were found. Textual content analysis revealed inconsistent and or missing competency definitions and theoretical frameworks with competencies proliferating over time. Taxonomy analysis identified minimal competencies at higher complexity levels according to Bloom's revised taxonomy.

CONCLUSIONS

Analyzed competencies lack reliability and validity testing, making assessment difficult for PHN educators and practitioners. Multiple and competing competencies further erode PHN's visibility, even among public health nurses. With unending revisions of PHN competencies and lack of supporting evidence regarding their effect and their integration into education or practice, recommendations for future efforts are offered.

Stakeholder Engagement in Competency Framework Development in Health Professions: A Systematic Review

Competency framework development in health professions has downstream implications for all relevant stakeholders, from the professionals themselves, to organisations, and most importantly end users of services. However, there is little guidance related to what stakeholders might be involved in the competency development process, and when. This review aimed to systematically review literature related to competency framework development methodology in health, to identify the breadth and purpose of key stakeholders commonly involved in the process. Studies were identified using five electronic databases (MEDLINE, PubMed, CINAHL, EMBASE, and ERIC) and a search of websites of organisations involved in curriculum or regulation using keywords related to competency frameworks. The total yield from all databases was 10,625 results, with 73 articles included in the final review. Most articles were from Australia (30%) and were conducted in the nursing (34%) profession. Unsurprisingly, practitioners (86%) and academics (75%) were typically engaged as stakeholders in competency framework development. While many competency frameworks were described as patient-focused, only 14 (19%) studies elected to include service users as stakeholders. Similarly, despite the multi-disciplinary focus described in some frameworks, only nine (12%) studies involved practitioners from other professions. Limiting the conceptualisation of competence to that determined by members of the profession itself may not provide the depth of insight required to capture the complexity of healthcare and address the needs of important stakeholder groups. Future methodology should attempt to engage a variety of relevant stakeholders such as external health professions and the community to match professional education to health service demands. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=128350.

Nurses' competency in Saudi Arabian healthcare context: A cross-sectional correlational study

AIM

To measure the competence and characteristics of nurses in Saudi Arabia delivering health care with significant correlations.

DESIGN

A cross-sectional correlational study.

METHODS

Data were collected in 2019 using a standardized questionnaire, Competency Inventory for Registered Nurses (CIRN), that included a purposive sample of 621 nurses working in Saudi Arabia.

RESULTS

A positive evaluation of nurses' overall core competency components is recognizably measured with greater competency levels in their workplace, scoring highest in "legal/ethical practice" while "critical thinking and research aptitude" represented the lowest dimension. Nurses' marital status, years of graduation, length of service, duty hours and nurse-patient ratio affect their competency level. Nurses' competence and their sociodemographic characteristics are significantly correlated attributes. Medical ward nurses are likely to have the greatest competence in delivering safe nursing care within training's legal borders.

Development and Validation of an Instrument to Measure Work-Related Stress among Rescue Workers in Traumatic Mass-Casualty Disasters

Rescue workers are a population at high-risk for mental problems as they are exposed to work-related stress from confrontation with traumatic events when responding to a disaster. A reliable measure is needed to assess rescue workers’ work-related stress from their surveillance of a disaster scene to help prevent severe PTSD and depressive symptoms. The purpose of this study was to develop and validate the Work-Related Stress Scale (WRSS) designed to measure stress in rescue workers after responding to traumatic mass-casualty events. An exploratory sequential mixed methods procedure was employed. The qualitative phase of the item generation component involved in-depth interviews of 7 experienced rescue workers from multiple specialties who had taken part in 1 or 2 mass-casualty events: the 2018 Hualien earthquake or the 2016 Tainan earthquake. In the quantitative phase, a modified Delphi approach was used to achieve consensus ratings by the same 7 raters on the items and to assess content validity. Construct validity was determined by confirmatory factor analysis using a broader sample of 293 rescue workers who had taken part in 1 of 2 mass-casualty events: the 2018 Hualien earthquake or the 2021 Hualien train derailment. The final WRSS consists of 16 items total and 4 subscales: Physical Demands, Psychological Response, Environmental Interruption, and Leadership, with aggregated alphas of 0.74–0.88. The WRSS was found to have psychometric integrity as a measure of stress in rescue workers after responding to a disaster.

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.].

Exploring healthcare professionals' perceptions of artificial intelligence: Validating a questionnaire using the e-Delphi method

Objective

The aim of this study was to draw upon the collective knowledge of experts in the fields of health and technology to develop a questionnaire that measured healthcare professionals' perceptions of Artificial Intelligence (AI).

Methods

The panel for this study were carefully selected participants who demonstrated an interest and/or involvement in AI from the fields of health or information technology. Recruitment was accomplished via email which invited the panel member to participate and included study and consent information. Data were collected from three rounds in the form of an online survey, an online group meeting and email communication. A 75% median threshold was used to define consensus.

Results

Between January and March 2019, five healthcare professionals and three IT experts participated in three rounds of study to reach consensus on the structure and content of the questionnaire. In Round 1 panel members identified issues about general understanding of AI and achieved consensus on nine draft questionnaire items. In Round 2 the panel achieved consensus on demographic questions and comprehensive group discussion resulted in the development of two further questionnaire items for inclusion. In a final e-Delphi round, a draft of the final questionnaire was distributed via email to the panel members for comment. No further amendments were put forward and 100% consensus was achieved.

Conclusion

A modified e-Delphi method was used to validate and develop a questionnaire to explore healthcare professionals' perceptions of AI. The e-Delphi method was successful in achieving consensus from an interdisciplinary panel of experts from health and IT. Further research is recommended to test the reliability of this questionnaire.

Global standards for professional nursing education: The time is now

A well-educated, professional nursing workforce is essential to good health care outcomes. Although nursing education is being strengthened globally, considerable diversity persists in the level and standards of nursing education both within and across countries. An international framework of guidelines for nursing education has, therefore, been developed to promote greater international consistency and high-quality nursing education globally. The purpose of this paper is to discuss the multinational methodology used to develop a global framework for professional nursing education and the policy implications of this framework in guiding the harmonization of nursing education demanded by the State of the World's Nursing 2020 (WHO, 2020a) call to action. The framework includes the underpinning assumption that nurses be prepared at the baccalaureate level and three pillars of global expectations targeting: a) learning outcomes for graduating preservice nursing students; b) standards for nursing programs, and c) standards for educational institutions delivering nursing programs. The Global Pillars Framework reflects international best practices, but the guidelines are adaptable across socio-cultural contexts facilitating the integration of locally relevant education. As 2020 has been declared the Year of the Nurse and Midwife globally, the ground has been laid for the next evolution in the education of the nursing workforce globally.

Adaptation and validation of a nursing competencies framework for clinical practice on a continuum of care from childhood to adulthood: A Delphi study

BACKGROUND

Too few of nursing competencies framework exceed applicability to a given environment, are validated by a research process or used to guide continuing development of nursing competencies.

OBJECTIVES

The study objectives were: 1) to adapt and validate a nursing competencies framework from the continuum of care from childhood to adulthood and 2) to explore implementation strategies.

DESIGN

A collaborative approach including nurses from different practice perspectives. A modified Delphi method supported the adaptation and the validation of a nursing competencies framework.

SETTING

This study was conducted in a pediatric and an adult care university hospitals in Montreal.

PARTICIPANTS

Forty-two nurses were recruited from both university hospitals.

METHODS

A modified Delphi study was conducted. An online questionnaire, containing dichotomous and open-ended questions, was used to collect data on the nursing competencies framework and the suggested implementation strategies for its use. Consensus percentage was calculated, and thematic analysis was used to analyze nurses' comments and implementation strategies suggested.

RESULTS

The nursing competencies framework (NCF), adapted and validated in this study, includes seven competencies and four development stages, from advanced beginner to clinical expert nurses. After three rounds, the nursing competencies framework describes the professional role from the continuum of care from childhood to adulthood, and proposes a self-assessment tool that promotes professional development and continuing education of nurses. Moreover, four strategies for implementing the framework in the clinical setting obtained a consensus of 70% or more.

CONCLUSIONS

A nursing competencies framework was validated by a rigorous research process and adapted to diverse contexts of care. The results revealed a common vision of the nursing practice for patients and their families on the life course from childhood to adulthood. This innovative framework carries the potential to be a relevant and unique reference tool. The nursing competencies framework can provide guidance for the development of nurses' competencies in clinical setting. Additionally, it is a relevant reference that should be use for knowing the scope and the standards of the professional practice in nursing education.

Developing the 2020 Diabetes Care & Education Specialist Competencies: A Modified Delphi Study

Purpose

The purpose of the study was to develop diabetes care and education specialty competencies that align with the Association of Diabetes Care & Education Specialists (ADCES).

Method

A Delphi method of consensus development was used, comprising 5 survey rounds. Interprofessional diabetes specialty experts were asked to identify and rate trends and issues important to diabetes specialists on a global scale. Use of a 5-round Delphi process allowed diabetes care and education specialty experts to refine their views considering the progress of the group’s work from round to round.

Results

A total of 457 diabetes care and education specialists across the United States in various professions participated in the Delphi rounds to identify a final set of 130 competencies across 6 domains.

Conclusion

Use of the Delphi method as a consensus guideline helped to identify core competencies for diabetes care and education specialists, reflecting the knowledge and skills necessary to provide evidence-based, high-quality care.

Opening the doors for school health-An exploration of public health nurses' capacities to engage in comprehensive school health programs

OBJECTIVES

Public health nurses (PHNs) have a significant role in engaging the voice and actions of school communities in promoting the health of children and youth. School nursing was one of the early 20th century public health nursing foci and specialties in Canada, however over several decades, there has been a gap in actualizing PHNs' full potential in schools. At the same time, intersectoral and interdisciplinary comprehensive school health (CSH) models have emerged as exemplars of partnerships between schools and communities to advance health promotion and ultimately chronic disease prevention with school populations (Pan-Canadian Joint Consortium for School Health, ; World Health Organization, ).

DESIGN AND MEASUREMENT

Using a participatory action research methodology we explored the role of PHNs in CSH, drawing on the concept of engagement in intersectoral healthy school teams.

RESULTS AND CONCLUSIONS

The three themes that emerged from the data analysis were: facilitators of public health nursing engagement, barriers to public health nursing engagement, and the influences of community context on engagement. Overall, findings indicate that the PHN role in CSH must be developed and supported so that PHNs remain a vital link between school health communities, programs, and policies in the promotion of health.