Competence and British nursing: a view from history

Revealing historical perspectives on the professionalization of nursing education in Norway-Dilemmas in the past and the present

The professionalization of modern nursing education from 1850 and forward is closely linked to values and virtues underpinned by Christian ideals, sex-based stereotypes and class. Development in the late 19th century of modern hospital medicine, combined with a scientific understanding of antisepsis and asepsis, hygiene, contagion prevention and germ theory, were highly influential insights to the dominant position of modern medicine in health care. This development constituted a key premise for what nurses, by virtue of being women, and combined with their education, could offer in terms of medical assistance. It enabled them to challenge the prevailing sex-based stereotypes- and class-based hierarchies, allowing modern nursing to retain aspects of both traditional Christian and womanly values, while at the same time adhering to the medical science paradigm. In this paper, we argue that modern nursing education developed in a context characterized by traditional female and religious values, while at the same time being increasingly dominated by the influence of scientific and medical progress. This conflict between traditional and modern values caused dilemmas and tensions as the nursing profession developed. We argue further that similar dilemmas and tensions continue to pervade contemporary nursing and nursing education.

The moderating effect of burnout on professionalism, values, and competence of nurses in Saudi Arabia amidst the COVID-19 pandemic: A structural equation modeling approach

Aim

To examine the moderating effect of burnout on the relationship between nurses' competence, professional competence and professional values.

Background

There is a preponderance of burnout studies of nurses before and during the COVID‐19 pandemic. However, little is known about burnout's moderating influence on nurses' professionalism, competence and values during the ongoing pandemic.

Methods

This study used a correlational, cross‐sectional design and convenience sampling to recruit 809 Saudi nurses employed in four government hospitals. Four self‐report instruments were used to collect data from August 2021 to March 2022. Spearman Rho, structural equation modelling and multi‐group moderation analysis were used to analyse the data.

Results

Most of the participants had high burnout. There was a moderate to high correlation between the dimensions of professional competence, nurse professional values, burnout and nurse competence. Both professional competence and nurse professional values significantly affected nurse competence. Nurse professional values also had a direct effect on professional competence. Professional competence and nurse professional values on nurse competence may vary among those with low, moderate and high levels of burnout, suggesting the moderating effect of burnout.

Conclusions

The positive impacts of nurse professional values and professional competence on nursing competence were validated in this study, as was the evidence of burnout's moderating effect on the studied connections. To avoid burnout, it is necessary to increase organizational knowledge and support for nurses, their working conditions and the environment through strategies that promote well‐being and empowerment.

Implications for nursing management

Nurse managers can implement policies to help nurses minimize burnout and improve their professional values and competence. Management policies may be considered include increased staffing, opportunities to improve technical abilities through education and vocational training programs, and increased diversity of job assignments.

An analysis of nursing students’ ethical conflicts in a hospital

Background:

Education can be taken as a key factor in transmission of a value tradition in healthcare. In professional and educational contexts, transmission of values appears to be a kind of guarantee for an occupational group’s professional identity, awareness and ethical integrity. Given the positives of such transmission of value traditions, one can also pay attention to conflicts between the professional tradition and individuals who are brought into that tradition.

Objectives:

How does mediation of value tradition in healthcare education appear out of the students’ perspective based on their own narratives?

Research design and participants:

Students’ texts were analysed through a combination of contrastive discourse analysis and sociohistorical description and then evaluated from an ethical perspective. Data were collected from the annual electronic feedback given by students after their clinical practice at a University Hospital.

Ethical considerations:

Organizational approval was received. Information about the voluntary nature of participation was a part of the feedback tool.

Findings:

The analysis points to the fact that there is a definite theme in the students’ experiences that both the previous research has neglected and that stands in conflict with the current tradition of healthcare education in Finland. That theme can be summarized in the experience of ‘losing one’s identity’, and it is expressed in a request to experience of ‘losing one’s identity’ and it is expressed in a request to have a right to ‘use one’s own name’ also as a healthcare professional.

Discussion and conclusion:

Being addressed by one’s name is to make the person directly involved and responsible, realizing that that person’s perspective is of importance to the way the world is. We argue that this theme (my name) is of ethical importance and could have empowering potentiality when used in an ethically sound way.

Practice development: a concept analysis

Exploration of the term `practice development' is required for the discipline of infection control nursing. Improved understanding of the term would allow practitioners to approach practice development in a more constructive and measurable fashion. A concept analysis based on the model of Walker and Avant is therefore presented. The analysis includes the definition of the term `practice development' and discussion of how it is presented in the literature. Illustrative cases are used to achieve clarification of the concept, culminating in identification of the empirical referents, these being: (1) identified patient need and (2) a change in nursing practice and demonstrably improved care.

Iranian nurses’ professional competence in spiritual care in 2014

Background:

The holistic approach views the human as a bio-psycho-socio-spiritual being. Evidence suggests that among these dimensions, the spiritual one is largely ignored in healthcare settings.

Objectives:

This study aimed to evaluate Iranian nurses’ perceived professional competence in spiritual care, the relationship between perceived competence and nurses’ personal characteristics, and barriers to provide spiritual care.

Research design:

A cross-sectional study was conducted in the year 2014.

Participants and research context:

The study population consisted of nurses working in teaching hospitals in Kashan city. Using a stratified, systematic random method, 250 samples were selected from a total of 1400 nurses. An indigenous instrument was used to assess the nurses’ competencies in spiritual care.

Ethical considerations:

A research ethics committee approved the study. All the participants were briefed on the study aims, were assured of the confidentiality of their personal information, and signed a written informed consent.

Results:

Among a total of 250 nurses, 239 answered the questionnaire completely, and in total, 23%, 51%, and 26% had poor, moderate, and favorable competence in spiritual care, respectively. No significant differences were found between the mean competence scores of spiritual care in terms of gender, marital status, employment status, and level of qualification. Significant difference was found between nurses’ overall score of competence in spiritual care and receiving training on spiritual care, nurses’ position, and the ward they worked in.

Discussion:

Confirming the findings of the international literature, this study puts light on the situation of nurses’ perceived competence and barriers to providing spiritual care in Iran as an eastern and Islamic context.

Conclusion:

Three-quarters of the nurses had moderate or unfavorable competence in spiritual care. Due to the crucial role of spiritual care in quality of care and patient satisfaction, nurses should be trained and supported to provide spiritual care.

Research literature production on nursing competences from 1981 till 2012: A bibliometric snapshot

BACKGROUND

When nurse education has moved away from a hospital based apprenticeship to a higher education institutions and new EU legislature enabled nurse workforce mobility, the term "competence" became an important concept in nurse education and practice. However, there is still a lot of confusion about its definition, how it should be assessed and implemented and which competences does a contemporary nurse need.

OBJECTIVES

To find publishing patterns in the nursing competence research literature production, focusing on publishing dynamics, identifying prolific research entities, most cited papers, and visualising the content of the research.

DESIGN AND DATA SOURCES

A bibliometric analysis of 370 information sources (288 original papers and 82 review articles) found in the Scopus database using the search string "nursing competenc*" for the period 1981-2012 was conducted. The SciMago database was used to identify country and source title ranks.

METHODS

Common elements of bibliometric data were extracted from each information source. Descriptive, correspondence and text analyses were used on the retrieved bibliometric data.

RESULTS

The production of research literature has a positive trend. The research on nursing competences is being performed on all five continents, however is not yet published in top journals. Most prolific countries are the United States of America, the United Kingdom and Australasia, and most prolific source titles are the Journal of clinical nursing, the Journal of nursing education and Public health nursing. The results confirmed the still persisting confusion in the definition of the competence and the emergence of the need for defining new nursing competences.

CONCLUSIONS

Study confirmed that there are still open questions in the nursing competence research that will require actions on different levels including policy makers, educators and practising nurses.

The enhancement of clinical competence through caring science

This theoretical research attempts to create a new basis for dialogue between two independent research fields that are connected by an inseparable link. The first, nursing science, is a body of professional knowledge, while the second, caring as an independent body of pure knowledge, conducts basic research with an aspiration towards applicability. This theoretical research uses the guidelines of the Buberian dialogue, which provides new meaning to the concept of clinical competence. The results emphasise the need to adopt abstract knowledge into the nursing field in order to improve the graduate's clinical capabilities. The combination of assessing clinical capability in a judgmental manner together with the dialogical humanistic approach of caring science may create a genuine platform and meeting event as a maturing process, which is intended to promote educational goals, which subsequently receive new meaning, that is, a different type of assessment. However, this assessment cannot be measured since a wide range of ethical moral aspects regarding both the student and the patient will have to be included. Nevertheless, this dialogue between nursing science and caring science can implement evidence on the basis of trust and can be used as a dialogical tool for evaluating clinical skills with the goal of empowering the educational field in nursing. Consequently, this clinical competence is called 'caring maturing means', and the goal is to convert the learning process into a meaningful event with the aim of improvement.

Nurses’ perceptions of their professional rights

The purpose of this study, which is part of a wider study of professional ethics, was to describe nurses’ perceptions of their rights in Italy. The data were collected by open-ended focus group interviews and analyzed with inductive content analysis. Based on the analysis, three main themes were identified. The first theme “Unfamiliarity with rights” described nurses’ perception that their rights mirrored historical roots, educational content, and nurses’ and patients’ position in the society. The second theme, “Rights reflected in legislation” highlighted that working and professional Italian legislation played a strong role. The third theme, “Managerial barriers for nurses’ rights” underlined the nurses’ perceptions that nursing management had the responsibility to create the conditions where nurses’ rights could flourish. This study intends to contribute to the debate on this underexplored topic.

Nurse competence: a concept analysis

PURPOSE

  The purpose of this analysis was to explore the concept of nurse competence.

DATA SOURCES

  Data sources include EBSCOhost, Gale PowerSearch, ProQuest, PubMed Medline, Google Scholar, and Online Journal of Issues in Nursing.

DATA SYNTHESIS

  This paper utilizes Rodgers' evolutionary method to analyze the concept of nurse competence.

CONCLUSION

  Antecedents to nurse competence include personal and external motivations. Attributes include integrating knowledge into practice, experience, critical thinking, proficient skills, caring, communication, environment, motivation, and professionalism. Consequences include confidence, safe practice, and holistic care. Implications for nursing responsibility regarding defining nurse competence and ensuring nurse competence need to be identified. More research is needed to determine the best evaluation methods for the different facets of nurse competence.

The use of skills inventories to assess and grade practice: Part 1--design and implementation

Employers increasingly require evidence of competent practice and cost-effective education that is fit for purpose. Historically, universities providing nurse education have been more concerned with the testing and grading of theory at undergraduate level which ultimately defines degree classification. This may be at the expense of recognising excellence in clinical practice which should be the ultimate goal of any nurse education programme. This paper reviews the development and introduction of an assessment tool to grade clinical competence in higher education level 6 post-registration critical care courses using a skills-based assessment strategy. The knowledge and practice components for each skill are defined within a standardised template. A number of skills pertinent to the area of practice and academic module are then collected in a skills inventory for assessment and grading which contribute to degree classification.

The snapshot pre-registration assessment tool. Part 1: background, literature and research

This is the first of a two-part article that presents a new assessment tool - the snapshot - for pre-registration nurses in clinical practice, that is being used at Kingston University/St George's University of London during year 3 of the Diploma and BSc programmes. A pilot study of the use of the snapshot in a simulation environment had previously been undertaken and as a result of this, the snapshot was piloted as part of continuous clinical assessment in practice on two cohorts of third-year pre-registration student nurses. An evaluative study was undertaken. This article describes the background to the project, the literature and the research methods used to undertake the evaluative research study. Part 2 will focus on the findings and a discussion of these findings mapped against the literature.

Acute nursing episodes which challenge graduate's competence: perceptions of registered nurses

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.

Autonomous decision making and moral capacities

This article examines how people with type 2 diabetes perceive autonomous decision making and which moral capacities they consider important in diabetes nurses' support of autonomous decision making. Fifteen older adults with type 2 diabetes were interviewed in a nurse-led unit. First, the data were analysed using the grounded theory method. The participants described a variety of decision-making processes in the nurse and family care-giver context. Later, descriptions of the decision-making processes were analysed using hermeneutic text interpretation. We suggest first- and second-order moral capacities that nurses specializing in diabetes need to promote the autonomous decision making of their patients. We recommend nurses to engage in ongoing, interactive reflective practice to further develop these moral capacities.

Competency: a concept analysis

TOPIC

Concept analysis of competency.

PURPOSE

The purpose of this concept analysis was to further explore uses of the concept and theoretically define how important the multidimensional aspects of competency are to the professional practice of nursing.

SOURCE OF INFORMATION

Published literature.

CONCLUSIONS

Competency is essential to the profession of nursing, and providing a clear theoretical definition of competency is only the first step. The competency of all nurses and healthcare providers must be assessed to provide safe care, protect the public, and maintain the credibility of nurses. Standards must be established and adhered to both in practice and evaluation of competency.

Types of nursing knowledge used to guide care of hospitalized patients

AIM

This paper is a report of a study to identify the types of nursing knowledge used to guide care of hospitalized patients.

BACKGROUND

The history of nursing knowledge is discerned in three distinct moments. The first historical moment conceives nursing knowledge as the acquisition of a set of descriptive rules, the second as the development of dualist explanatory theories and the third as the production of critical and/or integrative understandings. It remains unclear how these different types of knowledge are implemented in practice and how they affect the care of hospitalized patients.

METHOD

A secondary qualitative analysis was conducted in 2007 on original data collected in 2002. The data were read with focus on the knowledge used by participants to confront practice situations. They were interpreted, classified and indexed to identify types of knowledge nurses use to care for hospitalized patients.

FINDINGS

Five discrete types of nursing knowledge that nurses use in practice emerged: personal practice knowledge, theoretical knowledge, procedural knowledge, ward cultural knowledge and reflexive knowledge.

CONCLUSION

All three moments in the history of nursing knowledge were found to be concurrently present in nursing practice. Ward cultural knowledge and procedural knowledge reflect the rule-based descriptive knowledge of the first moment, theoretical knowledge and personal practice knowledge reflect the explanatory dualist knowledge of the second moment and reflexive knowledge reflects the critical and integrative knowledge of the third moment.

Nursing competence 10 years on: fit for practice and purpose yet?

AIMS AND OBJECTIVES

This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments.

BACKGROUND

In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the 'knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day.

METHODS

This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn.

CONCLUSIONS

From 1923-1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses 'fit for practice and purpose' may still prevail.

RELEVANCE TO CLINICAL PRACTICE

The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice.

Teaching on the spiritual dimension in care to undergraduate nursing students: the content and teaching methods

The study unit on 'The spiritual dimension in care'had a Judeo-Christian orientation. It was introduced to the Diploma nursing curriculum at the University of Malta in the academic year 2002-2003. The aim was to increase students' awareness about the essence of spirituality in care so as to enable them to implement holistic care. Spirituality may or may not incorporate religiosity. Thus, believers may have spiritual needs which may include religious needs whilst the atheists and agnostics may still have spiritual needs. While considering secularisation, the Christian culture of Malta was addressed in this study unit. This article describes the content structure of the study unit based on the ASSET model (Narayanasamy, A., 1999. ASSET: a model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today 19, 274-285) and outlines the various teaching methods used. Following feedback from the first and second cohort groups in 2003 and 2004, respectively, the reviewed study unit was delivered to the third cohort group of students (n=65) in Semester 2 in the academic year 2004-2005. Apart from the use of traditional teaching methods, such as lessons and a seminar, other methods were used constantly throughout the study unit, for example, self-reflection exercises, case-studies and small group discussions to enhance learning. Recommendations are proposed to review the content of this study unit and to introduce other teaching methods for effective learning.

Of bedpans and ivory towers? Nurse academics’ identities and the sacred and profane: A Bernsteinian analysis and discussion paper

AIM

In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics' identities.

BACKGROUND

The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it.

METHOD

Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated.

FINDINGS

Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics' attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills.

CONCLUSIONS

To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing's development as an academic discipline.

Developing an integrated career and competency framework for diabetes nursing

AIMS AND OBJECTIVES

To describe the development of an integrated career and competency framework for diabetes nursing.

BACKGROUND

The UK Nursing and Midwifery Council provides a definition of competence, but the terminology used in relation to the subject is often ambiguous and confusing. These concepts are explored in relation to nursing practice and the different approaches to competency framework development are described. To work alongside the Royal College of Nursing (RCN) and Skills for Health competency initiatives, a Diabetes Nursing Strategy Group representing nurses working in diabetes care was formed to oversee the development of an integrated career and competency framework for diabetes nursing.

DESIGN

At the outset, the design was guided by the RCN Practice Development Team and employed qualitative methodology including the modified Delphi and nominal group technique.

METHODS

A purposive sample of nurses representing all sectors and grades of staff involved in diabetes care was invited to workshops to undertake a values clarification exercise. Content analysis was performed to identify themes. Further workshops identified areas of specialist practice and competence statements were developed and refined in a series of consultations.

RESULTS

Competence statements for a range of diabetes-related areas were produced for nurses at the levels of unregistered practitioners, competent nurses, experience/proficient nurses, senior practitioners/expert nurses and consultant nurses.

CONCLUSIONS

The description of the process of developing of the integrated career and competency framework should help other groups going through the same process. Relevance to clinical practice. In addition to helping groups identify a formula for the development of a competency framework, the framework itself is designed to provide a basis for educational programmes, personal career development and a tool for managers managing career progression within diabetes nursing.

Competence in nursing practice: A controversial concept – A focused review of literature

The competency-based approach to education, training and assessment has surfaced as a key policy in industrialised nations. Following the transition of nurse preparation to the higher education sector the need to attenuate the tension of interests between employer and educator arose. While the competency-based approach has the potential to fulfil this, the application of competence to nursing is controversial and little consensus exists on definition. This paper synthesises a significant volume of literature relating to the acceptability and definition of the concept of competence with regard to nursing practice. Subsequent to a focused review of literature, problems inherent to the definition and utilisation of the concept of nursing competence are discussed. Because nursing requires complex combinations of knowledge, performance, skills and attitudes, a holistic definition of competence needs to be agreed upon and operationalised. This could facilitate greater acceptance of the concept and also underpin the development of competency standards and the tools required for the assessment of such.

Is the humanistic view of the nurse role still alive--in spite of an academic education?

AIM

This paper is a report of a study exploring what 'being a good nurse' means by following nursing students during their pre-registration education and for some years after graduation.

BACKGROUND

There have been few studies focusing on the nurse role in the transition from student to experienced nurse. Studies with a qualitative design, in particular, are limited in number.

METHODS

A longitudinal survey design was adopted, using an open-ended questionnaire at the beginning of education (n = 164), just before graduation (n = 123), and 3-5 years after graduation (n = 77). The participants were students in the nursing programme at a Swedish university. The data were collected during the period 1993-2002. Latent and manifest content analyses were used.

FINDINGS

Four categories were identified in the data. 'To do good for others', with the sub-category 'to care for others', was most frequent over time and quite stable. The category 'to be competent and skilled' was frequent and increased over time. 'To have professional courage and pride' and 'to seek professional development' were mentioned to lesser extent and showed a slight increase over time. The meaning of being a good nurse grew in complexity over time and informants' professional awareness seemed to increase, especially concerning 'to be competent and skilled'.

CONCLUSION

Attention needs to be paid both to nursing education and practice. Clinical supervision given by nurses with Master's degrees is suggested in order to convey positive attitudes towards nursing development and research into practice. Further studies are needed to compare what 'a good nurse' means to graduate nurses and how they actually behave when performing good nursing care.

Nursing competencies for spiritual care

AIM AND OBJECTIVES

The aim of this paper is to reveal the main nursing competencies for spiritual care, which emerged from data collecting from qualified nurses in Malta.

BACKGROUND

For nurses to deliver spiritual care, they must be competent to provide care on a physical, mental, social and spiritual level. As spiritual care may be influenced by culture, this study explored the competencies for spiritual care from the Maltese nurses' perspective.

METHODS

A descriptive exploratory study investigated nurses' competencies in the delivery of spiritual care to patients with myocardial infarction. Data were collected by means of an open-ended questionnaire on qualified nurses (n=77) followed by an in-depth interview on a stratified random sample (n=14) of nurses from the same respondents.

RESULTS

The four main nursing competencies identified were associated with the role of the nurse as a professional and as an individual person; delivery of spiritual care by the nursing process; nurses' communication with patients, inter-disciplinary team and clinical/educational organizations and safeguarding ethical issues in care.

CONCLUSION

This study demonstrated the complexity of spiritual care, which requires nurses to increase their awareness of the uniqueness of each individual patient with regard to the connection between mind, body and spirit; the assessment of the spiritual status of patients during illness and the implementation of holistic care as recommended by the Nursing Code of Ethics.

RELEVANCE TO CLINICAL PRACTICE

These findings will enable nurses to consider the importance of spiritual care, which may allow them to help empower patients find meaning and purpose during times of illness. More emphasis should be put on spiritual care in the pre- and postregistration education. Further research to translate these main competencies into specific competencies will guide spiritual care.

Nurse education--the role of the nurse teacher

AIM

To explore and analyse the role of the nurse teacher.

BACKGROUND

This paper examines the issue of clinical credibility among nurse teachers which has been ongoing for over a decade. The move of nurse education from colleges of nursing to the Higher Education Institutes was seen in 1992. Since then, nurse teachers have been faced with the need to juggle the roles of teaching, administration, research and clinical support for students. Nursing students within these Higher Education Institutes require more than the traditional theoretical classroom teaching. Nurse teachers have a role beyond this in encouraging students to link theory with practice, and practice with theory. Therein lies a challenge for nurse teachers to ensure they remain credible within the clinical setting and continue to provide education and support, which is firmly grounded in both practice and theory.

METHOD

The authors have critically reviewed the evidence related to the role of the nurse teacher in an attempt to identify key concepts and ideas, assumptions, supporting examples and the implications for their role.

CONCLUSION

The role of the nurse teacher, it would appear, is a dynamic one that needs to engage actively the needs of the student. Nurses therefore need to be dynamic in their approach in order to respond to both local and global demands and ensure that students become competent, professional, knowledgeable and caring in their approach.

RELEVANCE TO CLINICAL PRACTICE

This paper demonstrates the complex and ever changing role of the nurse teacher. This paper attempts to help nurse teachers understand the complex nature of their role.

Competence in nursing practice: a controversial concept--a focused review of literature

The competency-based approach to education, training and assessment has surfaced as a key policy in industrialised nations. Following the transition of nurse preparation to the higher education sector the need to attenuate the tension of interests between employer and educator arose. While the competency-based approach has the potential to fulfil this, the application of competence to nursing is controversial and little consensus exists on definition. This paper synthesises a significant volume of literature relating to the acceptability and definition of the concept of competence with regard to nursing practice. Subsequent to a focused review of literature, problems inherent to the definition and utilisation of the concept of nursing competence are discussed. Because nursing requires complex combinations of knowledge, performance, skills and attitudes, a holistic definition of competence needs to be agreed upon and operationalised. This could facilitate greater acceptance of the concept and also underpin the development of competency standards and the tools required for the assessment of such.

The tensions between education and models of nurse preparation

This article seeks to explore the relationship that has evolved between the training and education models of nurse preparation since the creation of the NHS. Through the process of professional reflection it intends to investigate how each model develops the profession and enhances care delivery. It seeks to move away from an either/or approach that has dominated the nurse education debate, and instead seeks to identify the potential benefits, as well as the tensions, of trying to integrate these models into a modern context. In so doing, this article hopes to inform practitioners about the debate so that they can engage with it more fully and effectively.

Clinical competence assessment in nursing: a systematic review of the literature

BACKGROUND

The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use.

RESEARCH QUESTION

The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing.

DESIGN

A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms.

RESULTS

There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed.

CONCLUSION

The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

Exploring idealism in palliative nursing care through reflective practice and action research

This article describes a qualitative research project using a combination of action research and reflective practice. Six experienced registered nurses identified their tendency towards idealism in their palliative nursing practice, which they defined as the tendency to expect to be 100% effective all of the time in their work. Participants collaborated in generating and evaluating an action plan to recognize and manage the negative effects of idealism in their work expectations and behaviours. Participants expressed positive changes in their practice, based on adjusting their responses to their idealistic tendencies towards perfectionism.