Riitta Meretoja

Nurse Competence Scale: A systematic and psychometric review

AIMnThe aim of this study was to report a systematic and psychometric review.nnnBACKGROUNDnThe Nurse Competence Scale is currently the most widely used generic instrument to measure Registered Nurses competence in different phases of their careers. Based on a decade of research, this review provides a summary of the existing evidence.nnnDESIGNnA systematic literature review of research evidence and psychometric properties.nnnDATA SOURCESnNine databases from 2004 - October 2015.nnnREVIEW METHODSnWe retrieved scientific publications in English and Finnish. Two researchers performed data selection and appraised the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist.nnnRESULTSnA total of 30 studies reported in 43 publications were included. These consisted of over 11,000 competence assessments. Twenty studies were from Europe and 10 from outside Europe. In addition to experienced nurses, the Nurse Competence Scale has been used for the competence assessment of newly graduated nurses and nursing students, mainly in hospital settings. Length of work experience, age, higher education, permanent employment and participation in educational programmes correlated positively with competence. Variables including empowerment, commitment, practice environment, quality of care and critical thinking were also associated with higher competence. The Nurse Competence Scale has demonstrated good content validity and appropriate internal consistency.nnnCONCLUSIONnThe value of Nurse Competence Scale has been confirmed in determining relationships between background variables and competence. The instrument has been widely used with experienced and newly graduated nurses and their managers. Cross-cultural validation must be continued using rigorous methods.

Newly graduated nurses’ empowerment regarding professional competence and other work-related factors

BackgroundAlthough both nurse empowerment and competence are fundamental concepts of describing newly graduated nurses’ professional development and job satisfaction, only few studies exist on the relationship between these concepts. Therefore, the purpose of this study was to determine how newly graduated nurses assess their empowerment and to clarify professional competence compared to other work-related factors.MethodsA descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (nu2009=u2009318) in Finland. Empowerment was measured using the 19-item Qualities of an Empowered Nurse scale and the Nurse Competence Scale measured nurses’ self-assessed generic competence. In addition to demographic data, the background data included employment sector (public/private), job satisfaction, intent to change/leave job, work schedule (shifts/business hours) and assessments of the quality of care in the workplace. The data were analysed statistically by using Spearman’s correlation coefficient as well as the One-Way and Multivariate Analysis of Variance. Cronbach’s alpha coefficient was used to estimate the internal consistency.ResultsNewly graduated nurses perceived their level of empowerment and competence fairly high. The association between nurse empowerment and professional competence was statistically significant. Other variables correlating positively to empowerment included employment sector, age, job satisfaction, intent to change job, work schedule, and satisfaction with the quality of care in the work unit. The study indicates competence had the strongest effect on newly graduated nurses’ empowerment.ConclusionsNew graduates need support and career opportunities. In the future, nurses’ further education and nurse managers’ resources for supporting and empowering nurses should respond to the newly graduated nurses’ requisites for attractive and meaningful work.

Anaesthesia nursing education in the Nordic countries: Literature review

OBJECTIVESnThe purpose of this review was to analyse post-registration anaesthesia nursing education in the Nordic countries. The analysis was based on key determinants fundamental to analysing nursing education: 1) the sys]tem of anaesthesia nursing education, 2) entry requirements, 3) credits, the duration and the title or degree awarded, and 4) the amount of practical training.nnnMETHODSnA scoping review was approached in a systematic manner. The literature was analysed using deductive content analysis. Data was gathered based on key determinants. The data were quantified into frequencies and percentages to compare the similarities and differences of anaesthesia nursing.nnnRESULTSnThe Nordic countries have different types of post-registration anaesthesia nursing education from non-degree supplementary programmes to Masters degree programmes. Even though the entry requirements correspond between countries, many more differences than similarities in anaesthesia nursing education were noted. A title granting the right to work as a nurse anaesthetist can be obtained through a variety of educational systems, credit requirements, the duration, and the amount of practical training in post-registration anaesthesia nursing programmes.nnnCONCLUSIONnThis aim of the study was to analyse post-registration anaesthesia nursing education from the Nordic perspective. Harmonising the educational system and minimum education requirements in anaesthesia nursing education is recommended in order to facilitate free movement and assure the quality of care from the Nordic perspective. Since each Nordic country has its own native language, it was difficult to gather information from all the Nordic countries. Therefore, creating common educational database published in English can help to bench mark each countrys educational system.

Evidence of clinical competence by simulation, a hermeneutical observational study

Making the transition from theory to practise easier in nursing education through simulation is widely implemented all over the world, and there is research evidence of the positive effects of simulation. The pre-understanding for this study is based on a definition of clinical competence as encountering, knowing, performing, maturing and developing, and the hypothesis is that these categories should appear in simulated situations. The aim of the study was to explore the forms and expressions of clinical competence in simulated situations and furthermore to explore if and how clinical competence could be developed by simulation. An observational hermeneutic study with a hypothetic-deductive approach was used in 18 simulated situations with 39 bachelor degree nursing students. In the situations, the scenarios, the actors and the plots were described. The story told was the way from suffering to health in which three main plots emerged. The first was, doing as performing and knowing, which took the shape of knowing what to do, acting responsibly, using evidence and equipment, appearing confident and feeling comfortable, and sharing work and information with others. The second was, being as encountering the patient, which took the shape of being there for him/her and confirming by listening and answering. The third plot was becoming as maturing and developing which took the shape of learning in co-operation with other students. All the deductive categories, shapes and expressions appeared as dialectic patterns having their negative counterparts. The study showed that clinical competence can be made evident and developed by simulation and that the challenge is in encountering the patient and his/her suffering.

Endoscopy nurse as a patient care coordinator: the expanded role of the competent nurse in the gastroenterology setting.

Several methods are used to describe and evaluate competence profiles of registered nurses. A clinical ladder program based on P. Benners (1984; P. Benner et al., 1996) competency framework has been used for 20 years in a Finnish university hospital; to ensure the nurses strategic competencies and capability profiles, the Nurse Competence Scale (NCS) was developed for the self-assessment and the superiors review purposes (R. Meretoja, H. Isoaho, & H. Leino-Kilpi, 2004; R. Meretoja, H. Leino-Kilpi, & A. M. Kaira, 2004). In the gastroenterological endoscopy unit, competent nurses work role has been expanded to the proficient level. These nurses are working as patient care coordinators in multiprofessional groups. This expanded work role requires mastery of nursing care for the gastroenterological patients and also familiarity of the endoscopy processes and the clinical pathways. These endoscopy nurse coordinators most important work role is the effective management of situations, and they are also remarkable resources as preceptors and mentors to less experienced nurses and nursing students. This article describes endoscopy nurse coordinators expanded work role and competence profile in the frame of the clinical ladder program.

Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study

RATIONALnThe demand to increase nursing competence is brought on by the requirement of safe, accessible and more effective use of healthcare provider expertise. Clinical nurse specialist competency development dates back to the late 20th century; however, an examination of the literature reveals a lack of research and discussion to support the competency development.nnnOBJECTIVESnTo describe the formulation and validation process of the clinical nurse specialist core competencies.nnnDESIGNnExploratory sequential mixed-method design.nnnMETHODSnThis mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (nxa0=xa025, nxa0=xa022, nxa0=xa019); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (nxa0=xa07, nxa0=xa010); and IV) verification of competency criteria with practicing CNSs (nxa0=xa016). Data were analysed by both qualitative and quantitative analysis methods.nnnRESULTSnSeventy-four preliminary clinical nurse competency criteria were formulated in the first phase of the study. Through cross-mapping the competencies against the US and Canadian clinical nurse specialist competency sets, they were further concised to 61 criteria. The examination of Content Validity Indexes and experts comments led to the clarification and consequent inclusion of 50 criteria to the final scale, with Scale Content Validity Index Average of 0.94. The competency criteria were evaluated to be a solid set with potential to clarify and uniform the clinical nurse specialist roles.nnnCONCLUSIONSnThrough a rigorous research process, validated clinical nurse specialist competency criteria were formed with a high Scale Content Validity Index Average. The results allude to the potential of formulating international competency criteria to support global role clarity and understanding. However, further research is needed to validate the content and construct of the formulated competencies with a larger population across countries.

The CLES Scale as a National Quality Tool for Clinical Learning and Teaching

This chapter describes the systematic evaluation of the clinical learning environment in the Finnish HealthCare Services and offers initiatives to increase the quality elements of clinical practicum. The chapter also presents a practical case example from one hospital district.

Preceptors’ perceptions of the elements of a successful and an unsuccessful orientation period for newly graduated nurses

AIMnTo identify existing orientation patterns and to find elements that may enhance or impede successful orientation of newly graduated nurses.nnnBACKGROUNDnPreceptors have first-hand information concerning orientation and their opinions should not be forgotten when organisations develop their orientation processes.nnnMETHODnAn open-ended questionnaire was undertaken to collect data from preceptors (nxa0=xa0172) about the current orientation patterns. Data were analysed by using deductive content analysis and by quantifying the phrases.nnnRESULTSnCommunal commitment to the orientation process, strong professional orientation know-how and supportive leadership were the enhancing elements of successful orientation. Complex interpersonal relationship problems during orientation, inadequate orientation resources and the organisations structural and functional problems were the impeding elements of successful orientation.nnnCONCLUSIONSnWith the elements of successful orientation we ensure a supportive transition to practice for newly graduate nurses and possibilities to focus on good orientation practices for preceptors.nnnIMPLICATION FOR NURSING MANAGEMENTnNurse leaders play an important part in ensuring newly graduated nurses have a safe nursing career starting point and, for preceptors, opportunities to provide orientation that is as good as possible. Supportive leadership, sufficient resources and good interpersonal relationships should be the leading principles during newly graduated nurses orientation period.

Effectiveness of mobile cooperation intervention on students’ clinical learning outcomes: A randomized controlled trial

AIMSnThe aim of this study was to evaluate the effectiveness of the mobile cooperation intervention in improving the competence and self-efficacy of students and the quality of the clinical learning environment.nnnBACKGROUNDnFor students, the clinical practicum is challenging as such and moreover the student - teacher cooperation, which supports the clinical learning of the students, has become complicated. Mobile applications have potential but their role in facilitating this cooperation remains unknown.nnnDESIGNnA parallel-group randomized controlled trial.nnnMETHODSnData were collected between January-March 2015 in Finland. The nursing students were randomly allocated to an intervention group (Nxa0=xa052) or control group (Nxa0=xa050). The intervention group used a mobile application to cooperate with the teacher during the clinical practicum. The control group engaged in standard cooperation. The primary outcome was competence. The secondary outcomes comprised self-efficacy and the quality of the clinical learning environment. Nurse Competence Scale, Self-efficacy in Clinical Performance instrument and the Clinical Learning Environment, Supervision and Nurse Teacher scale were used for student self-assessments. For the main analysis, hierarchical linear mixed models were used with the intention-to-treat principle.nnnRESULTSnCompetence and self-efficacy showed no significant between-group differences in mean improvements, but significant improvements in both groups were detected over the 5xa0weeks. Satisfaction with the clinical learning environment showed no significant between-group differences, however, the role of the nurse teacher subscale, especially regarding cooperation, showed significant group differences.nnnCONCLUSIONnThe mobile cooperation intervention was not significantly effective in improving individual outcomes, but did seem to improve significantly some aspects of the contextual outcomes.nnnTRIAL REGISTRATION NUMBERnClinicalTrials.gov: NCT02635295.