Joanne Garside

A concept analysis of competence and its transition in nursing

Competence is one of the most commonly used words in nursing internationally, yet is a nebulous concept defined in diverse ways by different healthcare practitioners. The slippery nature of the concept often exists purely in the eye of the beholder however, the universal principles are deeply rooted in the measurement of the Registered Nurses (RN) ability to perform effectively. Competence is a simpler thing to define when recognising where it does not exist in the form of incompetence. The aim of this paper is to present finding from a concept analysis that explored various facets of competence, particularly how it has been interpreted, applied and transformed over the years within nurse education in the United Kingdom. The analysis utilised a systematic review of contemporary evidence base based on theory construction by Walker and Avant (2005), a primary concern being to understand the underpinning conceptual principles that define the concept of competence and competency development and how these may be used to inform our understandings. The analysis identified how influential academics and professional bodies have attempted to provide definitions and concluded that it may be the existence of so many of these definitions, which has compounded the conundrum of what competence really is.

A review of health-related quality of life patient-reported outcome measures in cardiovascular nursing

Background: The traditional use of physically focused outcome measures fails to capture holistic, quality of life issues of importance to patients. The relatively recent, rapidly growing interest in patient-reported outcome measures (PROMs) attests to this and clinicians are faced with difficult decisions regarding their choice and use. Aims: The purpose of this review was to identify and synthesise the literature pertaining to the concept of quality of life and the main PROMs used to measure this in the cardiovascular field. Methods: A review of the recent literature was undertaken on commonly used cardiovascular health-related quality of life (HRQoL) PROMs. Results: Two types of HRQoL PROMs are available: disease-specific and generic. Both have limitations, and in many instances there is merit in using a combination, depending on the medical condition and treatment. In addition to psychometric considerations such as reliability, validity and responsiveness, the choice of a PROM will depend on factors such as the patient/investigator burden its use may impose, resources, costs, intellectual property and copyright issues. A new ‘hybrid’ HRQoL PROM for use in patients across the main cardiovascular disease presentations – angina, myocardial infarction and heart failure – appears to show promise. Conclusions: Cardiovascular HRQoL PROMs have a wide variety of uses and can help clinicians, researchers, managers and policy makers in decision making and provide indicators of clinical and institutional quality and outcomes. New HRQoL PROMs are emerging and their choice and use should be determined by a host of issues, including psychometric properties, acceptability, feasibility and cost.

Repositioning assessment: Giving students the 'choice' of assessment methods

Assessment is a feature of all academic courses undertaken for award in the United Kingdom (UK). The nature of the strategies that can be used to assess learning vary a great deal from the traditional unseen examination to more student-centered innovative approaches. A review of a pre-registration nursing curriculum in preparation for re-approval by the University and Nurse Midwifery Council (NMC) provided an opportunity to re-appraise existing assessment strategies. Concurrently a parallel review process was underway with a postgraduate continuing professional development (CPD) programme for registered nurses. Recognising that students have individual strengths, weaknesses, learning styles and preferences concerning mode of assessment, offering choice of assessment was proposed as a strategy for inculcating the values of student centeredness and responsibility for learning. Although recommended in the literature (Race et al., 2005 and Cowan, J., 2006. On Becoming an Innovative University Teacher: Reflection in Action. University Press, Open Maidenhead.) no empirical evidence of benefit in support of this initiative was identified. This paper presents an account of the journey taken by the project team from original idea, navigation of the quality assurance processes associated with curriculum approval to delivery of choice of assessment on two modules embedded in an undergraduate pre-registration and post-registration CPD programmes, and an evaluation undertaken with the students. Offering students choice of assessment appears to be well received and this approach has subsequently been adopted as a feature of other health and social care professional programmes offered in the institution.

Sedation and its psychological effects following intensive care

Significant psychological impacts, including post-traumatic stress disorder (PTSD), have been associated with patients under sedation in intensive care units (ICUs). However, it remains unknown if and how sedation is related to post-ICU psychological outcomes. This literature review explores the relationships between sedation, the depth of sedation and psychological disorders. A review of existing literature was undertaken systematically with key terms and included peer-reviewed primary research and randomised controlled trials (RCTs). To ensure subject relevance pre-2006, non-English and paediatric-based research was excluded. Findings highlighted that reduced sedation levels did not significantly reduce the outcome of PTSD, yet reduced ICU length of stay and length of mechanical ventilation (MV) were both associated with lighter sedation. Further research is recommended into more specific factual and delusional memories post ICU in relation to the level of sedation and to psychological distress.

Developing a culture of publication: a joint enterprise writing retreat

Purpose – Many students irrespective of level of study produce excellent course work which, if given support and encouragement, could clearly be of a publishable standard. Academic staff are expected to produce quality publications meeting peer-review standards although they may be relatively novice authors. All are engaged in some aspects of academic writing practices but not as frequently involved in co-production of publications emanating from student work. This activity is still at the margins of much of the student experience. The paper aims to discuss these issues. Design/methodology/approach – Mindful of these issues, the authors designed and offered a writing programme including a writing retreat. This brought together undergraduate and postgraduate students from a range of applied disciplines (health and art, design and architecture) and their supervisors with the aim of co-producing publications and participating in a community of scholarly practice. The project was delivered over nine months. I...

Changing Operating Lists on the Day of Surgery - a Service Evaluation

This study aims to explore how often the operating list is changed on the day of surgery and the reasons why this may occur. The purpose was to analyse the wider potential impact that changing the list on the day of surgery may have on patient safety, patient satisfaction and theatre efficiency. Survey data was collected across a multi-specialty elective operating department. The findings demonstrated that a significant change in operating lists occurred in 37.3% of sessions, for a variety of potentially avoidable reasons. We concluded that improved organisation and communication before the planned session could reduce the occurrence of changes, thereby increasing patient safety, theatre efficiency and potentially reducing incidents.

Care bundles in the management of a COPD exacerbation

Chronic obstructive pulmonary disease (COPD), the umbrella term used to describe chronic lung diseases that cause limitations in lung airflow, is predicted to be the third leading cause of death by 2030. COPD is said to affect 3 million people in the UK, resulting in approximately 30 000 deaths each year. Related healthcare costs continue to escalate, not least because of increasing readmission rates associated with COPD emergencies. The use of care bundles to streamline care is becoming more popular in an attempt to tackle this issue. An integrative literature review was carried out to examine the effectiveness of the use of care bundles. The findings highlighted inconsistencies in the components of bundles, leading to inherent difficulties in assessing which specific component of the bundles led to positive outcomes. The results of this attempt to establish the effectiveness of care bundles in reducing readmission rates and quality of care were inconclusive. The authors recommend further research to investigate the individual components in the bundles and to introduce internationally agreed care bundles for the management of COPD.

Emergency health education in a conflict stricken environment: A situational analysis

Introduction Bosasso General Hospital is located in Puntland Somalia, an area affected by prolonged civil conflict, terrorism, clan fighting and piracy. International evidence highlights that staff skills and competence may have a significant impact on patient outcomes however there has been little research on emergency education in such an austere and volatile environment. The purpose of this study therefore was to identify current practices and gaps in delivering emergency medicine education in this resource-deprived environment. Methods A mixed methods approach was adopted to inform convergent parallel data collection techniques including questionnaire (n = 16), key informant (n = 5) and focus group interviews (n = 16). Data analysis, following data triangulation, produced descriptive quantitative statistics of themes such as emergency care, educational provision, enablers and barriers. Results The research showed that among health care staff at the hospital, 19% of the nurses felt that visiting nurses offer some knowledge on emergency care, while 38% of knowledge was gained from visiting doctors. Regarding knowledge of emergency medicine, 88.9% of the nurses felt that emergency medicine is basically first aid. Discussion Emergency care was perceived by the majority as essentially ‘first aid’. Many indicated that they received little or no regular or formal training on emergency care and related essential topics. In terms of challenges faced in delivering emergency care education demonstrated a common factor in the limited resources available which included lack of teaching materials, reading materials, online resources, health care professionals, equipment and mentors. Conclusions drawn suggest that the knowledge of emergency medicine by front line professionals is limited. Therefore, the development of field curricula, practical and theoretical training by visiting practitioners, provision of additional teaching aids, tools and equipment, integration of multiple disciplines in training and financial resource mobilisation would be beneficial in improving knowledge, attitudes and practices of emergency care.