Development of competency based standards An application of the Delphi research technique

Nephrology nurses' perspectives working with patients experiencing needle-related distress

BACKGROUND

A key skill of nephrology nursing is cannulation of patients receiving haemodialysis. Traumatic and unsuccessful cannulation experiences, particularly in the initial weeks of haemodialysis, may contribute to the onset of needle distress for patients.

OBJECTIVES

To identify the key knowledge, skills and attitudes of nephrology nurses working with haemodialysis patients and the competencies relevant to nephrology nursing working with patients with needle-related distress.

DESIGN

A qualitative study involving semistructured interviews. Interviews were audio-recorded, transcribed and deductive, and inductive thematic analysis applied.

PARTICIPANTS

Nephrology nurses (n = 17) were interviewed from a tertiary kidney service in South Australia. Nurses had varying roles and years of experience (range 1-30 years) working with dialysis patients within the service.

RESULTS

Two overarching themes, (1) Flexibility in Practice and Care and (2) Responsibility of Nephrology Nursing, were identified as relevant across all knowledge, skills and attitudes of nephrology nurses working with patients with needle-related distress. Thirty-six knowledge, skills and attitudes were identified; 12 related to knowledge, 14 related to skills and 10 were identified as attitudes and were summarised under seven broad competencies.

CONCLUSION

This study identifies potential knowledge, skills and attitudes and competencies required for nephrology nurses working with patients with needle-related distress. It highlights strategies that may prevent the onset and worsening of needle-related distress, as well as reduce it. It also brings to light that nurses desire additional education regarding strategies to improve the patient experience of cannulation and nurse confidence and skill in this area.

A Delphi study to identify and assess professional competencies in the education of optometrists

PURPOSE

The aim of this study was to identify, assess, and reach a consensus on the professional competencies that optometrists must acquire during their undergraduate training at the University of Valladolid. The results obtained may be useful in the revision of the current curriculum.

METHODS

A three round Delphi study was carried out with the participation of 116 participants grouped in 7 panels. In the first round, competencies were identified through an open-ended question and their frequency calculated. In the successive 2nd and 3rd rounds, the consensus and stability of each competency was established.

RESULTS

A total of 56 professional competencies were identified, with 43 of them (77%) achieving a consensus among participants, of which the highest scores were obtained by the competencies that correspond to health functions of primary visual care. Out of the 13 competencies without consensus, for 11 of them this was due to the significant differences in assessment among the consulted participants; for 8 competencies (14%) response stability was found, while neither consensus nor stability were reached in 5 (9%) of the identified competencies.

CONCLUSIONS

The results obtained with this Delphi study provide a set of relevant competencies for updating the curriculum of the university Degree in Optics and Optometry at the University of Valladolid, improving its suitability to current and future professional reality.

Development and Validation of the WHO Rehabilitation Competency Framework: A Mixed Methods Study

OBJECTIVES

To identify the competencies, behaviors, activities, and tasks required by the rehabilitation workforce, and their core values and beliefs, and to validate these among rehabilitation professionals and service users.

DESIGN

Mixed methods study, involving a content analysis of rehabilitation-related competency frameworks, a modified Delphi study, and a consultation-based questionnaire of service users.

SETTING

Desk-based research.

PARTICIPANTS

Participants who completed the first (N=77; 47%) and second (N=68; 67%) iterations of the modified Delphi study. Thirty-seven individuals participated in the service user consultation. Collectively, the participants of the mixed methods study represented a significant range of rehabilitation professions from a broad range of countries, as well as both high- and low-income settings.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Not applicable.

RESULTS

The mixed methods study resulted in the inclusion of 4 core values, 4 core beliefs, 17 competencies, 56 behaviors, 20 activities, and 62 tasks in the Rehabilitation Competency Framework. The content analysis of rehabilitation-related competency frameworks produced an alpha list of competencies, behaviors, activities and tasks ("statements"), which were categorized into 5 domains. The final iteration of the modified Delphi study revealed an average of 95% agreement with the statements, whereas the service user consultation indicated an average of 87% agreement with the statements included in the questionnaire.

CONCLUSIONS

Despite the diverse composition of the rehabilitation workforce, this mixed methods study demonstrated that a strong consensus on competencies and behaviors that are shared across professions, specializations, and settings, and for activities and tasks that collectively capture the scope of rehabilitation practice. The development of the Rehabilitation Competency Framework is a pivotal step toward the twin goals of building workforce capability to improve quality of care and strengthening a common rehabilitation workforce identity that will bolster its visibility and influence at a systems-level.

A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses

BACKGROUND

Observational work to develop the ACCCN Competency Standards was undertaken more than 20 years ago. Since then the landscape of critical care nursing as a specialty has changed and it is not known if the Competency Standards reflected contemporary practice.

OBJECTIVES

To revise the ACCCN Competency Standards for Specialist Critical Care Nurses to ensure they continue to meet the needs of critical care nurses and reflect current practice.

METHODS

A two-phased project was undertaken. In Phase I focus groups were held in all states. Thematic analysis was conducted using two techniques. The standards were revised based on the main themes. Phase II consisted of an eDelphi technique. A national panel of critical care nurses responded to three survey rounds using a 7 point likert-type scale to indicate their level of agreement with the revised standards. A 70% agreement level for each statement was determined a priori.

RESULTS

Phase I: 12 focus groups (79 participants) were conducted. Phase II: A panel of specialist critical care nurses (research, management, clinical practice and education) responded to round 1 (n=64), round 2 (n=56), and round 3 (n=40). Fifteen practice standards with elements and performance criteria were grouped into four domains (professional practice, provision and coordination of care, critical thinking and analysis, collaboration and leadership). The revised Practice Standards for Specialist Critical Care Nurses build upon and are additional to the Nursing & Midwifery Board of Australia National Competency Standards for Registered Nurses. The standards reflect contemporary critical care nurse practices using an expanded range of technologies to care for complex critically ill patients across the lifespan in diverse settings.

CONCLUSION

The national study has resulted in the 3rd edition of the Practice Standards for Specialist Critical Care Nurses. There was input from stakeholders and agreement that the revised standards capture contemporary Australian critical care nursing practice.

Seeking evidence of rehabilitation in nephrology nursing

Individuals with renal failure experience many varied and complex alterations in their health status. As a consequence, rehabilitation is an important aspect of their care. However, until recently, rehabilitation has not been explicit in the published nephrology nursing literature. This paper addresses that deficit through an examination of Australian nephrology nursing competency standards for evidence of rehabilitation. Recent Australian research about rehabilitation nursing practice was used as a guiding definition of rehabilitation. A systematic examination of these documents revealed evidence of rehabilitative practices embedded in the nephrology nursing competency standards' domains of empowerment and clinical problem solving. These findings add support for the belief that rehabilitation is a philosophy that all nurses can apply in their practice.