A competency roadmap for advanced practice nursing education using PRIME-NP

Standardizing nurse practitioner clinical education: The Cognitive Preceptorship Model

BACKGROUND

Though preparing autonomous advanced nursing providers who are ready to care for complex clients in a variety of settings after graduation is necessary to achieve clinical competence, NP clinical education activities used to achieve competencies are greatly variable and hard to measure. The quality of students' clinical experiences impacts students' achievement of clinical competence (CC) and achieving CC is important for the NPs to successfully transition to practice after graduation.

AIM

The purpose of this project is to apply the Cognitive Preceptorship Model (CPM) to design, describe, and explain the clinical activities that are NP role-specific, that scaffold from the American Association of Colleges of Nursing (AACN), and National Organization of Nurse Practitioner Faculties (NONPF) competencies and that help NP students achieve competencies.

METHOD

CPM concepts, AACN and NONPF competencies were cross analyzed. NP role-specific clinical teaching and learning activities were designed, described, and displayed in a table.

CONCLUSION

AACN and NONPF competencies provide the foundation for competencies-based education, which is necessary to standardize NP students' learning outcomes; however, how these outcomes should be achieved in a clinical learning environment (CLE) should also be standardized. Using role-specific theoretical literature that is well aligned with the role competencies to guide the designing of clinical activities should assist in standardizing NP evidence-based clinical education.

The year-long journey: Transforming the BSN-DNP curriculum

BACKGROUND

Revising a doctor of nursing practice (DNP) curriculum for family nurse practitioner and psychiatric mental health nurse practitioner education with an eye on future changes in competencies required planning and consensus among taskforce members. Major priorities included: the need to embed competency- based education (CBE), the National Taskforce Criteria for Nurse Practitioner (6th ed.) education, and the Essentials: Core competencies for professional nursing education (American Association of Colleges of Nursing (AACN) Essentials, 2021).

FINDINGS

Challenges began with faculty knowledge of CBE, NP faculty skills in curriculum building, buying in to the revised degree, and reviewing all current literature on the DNP NP knowledge, skills and attitudes needed for current practice. The year long journey yielded a comprehensive curriculum model to share as well as several lessons learned and recommendations for this journey.

CONCLUSION

The process resulted in a curriculum revision that thus far, is better suited to development of the "work-ready" graduate while still supporting individualized student needs in attending a doctoral-level program. Ongoing work is focused on specific "pillars" of program support including clinical preceptor placement and partnerships, preceptor resources, student retention resources, and exploration of competency-based tracking data management. Considering the impact on faculty workload, program leadership should actively assess levels of curricular expertise of faculty involved to determine additional development or training needs for individual professional growth.

Strengthening the planning and design of Objective Structured Clinical Examinations

Background

Although Objective Structured Clinical Examinations (OSCEs) offer innovative, objective, and fair methods of clinical assessment, their quality is compromised by poor planning and design.

Aim

This study aimed to describe the development and present evidence-based recommendations on strengthening the planning and design of OSCEs for a South African public College of Nursing.

Setting

A South African public College of Nursing.

Methods

Recommendations were developed based on synthesising two sets of qualitative data. Set 1 included two main themes with each of the four sub-themes related to barriers and facilitators towards quality in OSCE designs from 14 nurse educator interviews and 15 external moderator reports. Set 2 included 12 quality measures to be adopted in the quality design of OSCEs derived from an integrative literature review. The draft recommendations were reviewed by eight experts to be finalised.

Results

Seven recommendations were developed for strengthening OSCEs' planning and design, related to: (1) policy framework, standard operating procedures and stakeholder code of conduct; (2) blueprinting and mapping of the OSCE content; (3) developing a bank of OSCE stations; (4) scoring rubric and standard-setting method selection; (5) examiners and standardised patients' recruitment and training; (6) venue selection; and (7) station piloting.

Conclusion

The seven developed recommendations can strengthen the quality of OSCEs in the South African public College of Nursing context.

Contribution

The developed recommendations can assist nurse educators in planning and designing to conduct quality OSCEs following piloting and implementation.

Stepping outside national borders: International active learning educational collaboration events

AIM

This paper discusses the benefits of international collaborations for advanced practice nursing education. It identifies new perspectives and innovative practices to enhance cultural competency.

BACKGROUND

Competent, well-trained advanced practice nurses (APNs) are necessary to provide high-quality and safe patient care, improve access to care, and address health disparities that are no longer geographically bound. In 2021, an international network of advanced practice educators established an active learning program to teach students their role in global citizenship and increase awareness of health disparities. APN students from Scotland, Wales, Minnesota, Houston, and Rotterdam participated in presentations, online discussions, and in-country scholarships.

SOURCES OF EVIDENCE

Growing health disparities have created the need for efficient international collaboration to develop new concepts, approaches, and bidirectional exchange of experiences, culture, and knowledge. Integrating global health into curricula engages students' curiosity and integrates education, research, practice, and leadership while improving cultural competency.

DISCUSSION

Forty-two students participated in the international presentations. The students strongly believed in the benefit of international collaboration and the need for a universal role for the advanced practice nurse. They responded positively to sharing cultural and clinical experiences.

CONCLUSION

The recent global health challenge supported the development of innovative methods to deliver education and created an opportunity for advanced practice students to develop cultural competence and critical thinking. Collaborative solutions are essential to education and healthcare as we move forward in the 21st century.

IMPLICATIONS FOR NURSING PRACTICE

Robust international collaborations have enabled the development of cultural competence and critical thinking. These are crucial elements for advanced practice roles.

PRIME-nurse practitioner competency model validation and criterion based OSCE rubric interrater reliability

The PRIME-NP (Professional-Reporter-Interpreter-Manager-Educator/Evaluation-Nurse Practitioner) Model is adapted from the RIME (Reporter-Interpreter-Manager-Educator) model used in medical education to guide medical student and resident education. The Delphi technique was used to validate the PRIME-NP Model. After two rounds of review by a group of experts in NP curriculum, the model was determined to be valid based on expert consensus. Agreement percent increase from the first round to the second round in all categories. Interrater reliability (IRR) was assessed using interclass correlation after instrument validation was completed for each of the five levels of the PRIME-NP model. Overall, the IRR of the instrument was found to be acceptable with some notable exceptions. No variance was noted in professional behaviors at any level. Variance was increased in management and educator/evaluator behaviors in higher/later course levels. The PRIME-NP Model and PRIME-NP OSCE Rubric is a valid and reliable instrument to assess NP student progression in objective structured clinical examinations. This instrument has the potential for adaptation for use in other types of health sciences education and settings.

Adaptation of the Gerontological Nursing Competence (GeroNursingCom) instrument to Turkish: Validity and reliability study

AIM

The aim of this study was to conduct a Turkish validity and reliability study of the Gerontological Nursing Competence Scale and to adapt the scale to Turkish culture.

BACKGROUND

As the number of older people increses, gerontological nursing requires specialized expertise in older people care. High-quality basic education and further education guarantee good competence in gerontological care.

DESIGN

A methodological study of instrument translation and validation.

METHODS

The study was methodological and the sample consisted of 530 university students who agreed to participate in the study. Data were collected by online interview method using the Introductory Information Form and Gerontological Nursing Competence Scale (GeroNursingCom). Before starting the study, permission was obtained from the ethics committee, the relevant institution, the scale owner and the students. Language equivalence and content validity of the scale were ensured and Confirmatory Factor Analysis Models (CFA) was conducted. Cronbach Alpha and item-total correlation analysis were used for the reliability of the scale.

RESULTS

The scale was compatible in terms of linguistic fidelity Content Validity Index (CVI) (Language)=0.97 and content fidelity CVI (Content)=0.96. The CFA results showed that the χ2/sd value was 1.861 and since this value was less than three, it can be stated that the model provided an excellent fit to the data. Comparative Fit Index (CFI) and Non-normalized Fit Index (NNFI) values were determined as 0.99 and 0.99 respectively and these values being above 0.90 indicate that the model provides an excellent fit to the data. Square Root of Standardized Errors (SRMR) index was 0.045 and Root Mean Square Error of Approximation (RMSEA) index was 0.040 and these values were less than 0.080, indicating that the model provided an excellent fit to the data. The Cronbach's alpha reliability coefficient of 0.97 was found to be highly reliable and the Cronbach's alpha reliability coefficients calculated for the sub-dimensions ranged between 0.77 and 0.91.

CONCLUSIONS

It was determined that the gerontological nursing competence scale is valid and reliable for nursing students and can be used in both student and working nurses living in Turkey.

Development of the Acute Care Nurse Practitioner Competencies Scale: An Exploratory and Confirmatory Factor Analysis

BACKGROUND

Nurse practitioners (NPs) play a vital role in healthcare, particularly in acute care settings in Taiwan. The professional competencies of NPs are essential for providing safe and effective care to patients. To date, no measurement tool is available for assessing the clinical competencies of NPs in acute care practices.

PURPOSE

The aim of this study was to develop and investigate the psychometric properties of the Acute Care Nurse Practitioner Competencies Scale (ACNPCS).

METHODS

Mixed-method research was employed using samples of experienced NPs. First, we used a focus group of seven experienced NPs who worked for medical centers, community hospitals, and regional hospitals to identify clinical competencies content. Second, we implemented consensus validation using two rounds of the Delphi study and revised it to a 39-item ACNPCS. Third, we conducted content validity with nine NP experts and modified the competency content to 36 items. Finally, we conducted a national survey of 390 NPs from 125 hospitals to determine the extent to which the NP competency content relates to their clinical practice. To examine the reliability of the tool, we tested the internal consistency reliability and test-retest reliability. Exploratory factor analysis, confirmatory factor analysis, and known-group validity were used to test the construct validity of the ACNPCS.

RESULTS

The Cronbach's alpha coefficient for the overall scale was .92, with subscale coefficients ranging from .71 to .89. Test-retest reliability showed the two scores of the ACNPCS on the two occasions tested to be highly correlated ( r = .85, p < .001). Exploratory factor analysis revealed that the scale had six factors: providing healthcare, evaluating care, collaboration, education, care quality/research, and leadership/professionalism. Factor loadings for each factor item ranged from .50 to .80 and explained 72.53% of the total variance in the NPs' competencies. Confirmatory factor analysis indicated that the six-factor model showed satisfactory model fit (χ 2 = 780.54, p < .01), and the fit indices met the standards for adequate fit (goodness-of-fit index = .90, comparative fit index = .98, Tucker-Lewis index = .97, root mean square error of approximation = .04, and standardized root mean residual = .04). Known-group validity revealed that the total scores for novice NPs differed significantly from those of expert NPs in terms of the competencies ( t = 3.26, p < .001). These results validated the psychometric soundness of the newly developed ACNPCS.

CONCLUSIONS

The newly developed ACNPCS exhibited satisfactory reliability and validity, supporting the use of the ACNPCS as a tool to assess the clinical competencies of NPs in acute care settings.

Exploring the core competencies of clinical nurses in chinese tertiary hospitals: a qualitative content analysis

BACKGROUND

With the changes in social and medical environments and people's health needs, the nursing core competency should be updated and developed promptly. This study aimed to explore the core competencies of nurses in Chinese tertiary hospitals under the new health development strategy.

METHODS

Descriptive qualitative research was conducted using qualitative content analysis. 20 clinical nurses and nursing managers from 11 different provinces and cities were interviewed via purposive sampling.

RESULTS

Data analysis revealed 27 competencies, which were grouped into three major categories according to the onion model. These categories were motivation and traits (responsibility, enterprise, etc.), professional philosophy and values (professionalism, career perception, etc.), and knowledge and skills (clinical nursing competency, leadership and management competency, etc.).

CONCLUSION

Based on the onion model, core competencies for nurses in Chinese tertiary hospitals were established, revealing three layers of core competencies and giving a theoretical reference for nursing managers to conduct competency training courses based on the competency levels.

Development of a Core Outcome Set for Randomised Controlled Trials of Nursing Education: A Methodological Framework

Background

Nursing educational research is very important for the development of the nursing discipline. There have been many randomised controlled trials (RCTs) of nursing education, and the outcomes are highly heterogeneous and waste resources. The study aims to report the methodological framework to establish a core outcome set (COS) for RCTs of nursing education.

Methods

The study will be conducted in the following five steps: (a) establish nursing education COS working groups; (b) develop an initial list of outcomes of nursing education by systematic review and semistructured interview; (c) Delphi survey with different stakeholders to reach a preliminary consensus on the core outcome of nursing education; (d) expert consultation to form the outcome pool; (e) expert consensus meeting to form the nursing education COS.

Results

The goal is to develop a COS that includes stakeholders' interest in nursing education to determine which outcomes should be reported and how they should be measured.

Conclusions

By performing the study, the nursing education COS will be established, which will help to reduce reporting bias and resource waste, and provide enough results for nursing education systematic reviews.

Applying the RIME Framework to Level Nurse Practitioner Curriculum Competencies

BACKGROUND

Nurse practitioner (NP) faculty assess student acquisition of knowledge through examinations, simulation, and clinical performance.

PROBLEM

Developing appropriately leveled curriculum, assessments, and clinical expectations that accurately capture student maturation presents a challenge.

APPROACH

The Reporter, Interpreter, Manager, Educator (RIME) provided the framework for doctor of nursing practice NP curriculum redesign to enhance student performance and content mastery. Faculty used a gap analysis approach, iteratively leveling specialty content, course competencies, examination questions, simulation cases, and clinical expectations using the building blocks of RIME.

OUTCOMES

Objective scores on student evaluations for clinical courses exceeded the threshold established, including 83% of simulation encounters. Faculty implemented targeted methods to remediate areas of underperformance.

CONCLUSIONS

Structuring the course competencies and preceptor feedback around RIME made it easier to pinpoint specific deficiencies and target remediation. It also helped guide discussions about the minimum acceptable standard for student performance.