Perceived Importance and Performance of Critical Care Nursing Competency by Nurses' Clinical Expertise.

Background and Purpose: To enhance critical care competency, it is necessary to develop and apply a clinical expertise-based competency training program. This study aimed to identify the perceived importance and performance of critical care nursing competency and the training priorities of competency-based training programs by nurses' clinical expertise. Methods: This was a cross-sectional descriptive survey with a convenience sample of 236 intensive care unit nurses. The critical care nursing competency of nurses was measured. Training needs were determined using an importance-performance analysis. Results: Competency areas with high training priority on the importance-performance matrix were skin assessment, emotional support, Code of Ethics, and collaboration for novice nurses, skin assessment and patient education for advanced beginner nurses, skin assessment and decision-making for competent nurses, and patient education and interprofessional collaboration for proficient nurses. Implications for Practice: Different training needs were identified according to the self-reported level of clinical expertise at four levels. Nursing administrators and educators should provide competency-based continuing education programs based on high-priority training areas according to the nurses' clinical expertise.

Ethical Coffee Room: An international collaboration in learning ethics digitally.

BACKGROUND: Ethics is a fundamental part of health care professionals' competence and one of the major quality factors in good nursing care. Research shows challenges in learning and applying ethics. Ethical Coffee Room is an electronic platform, where the students, nurses and teachers discuss anonymously ethical issues during students' clinical practice. ECR offers 1 credit (27 working hours) for the students. This work included reading theoretical material, contributions for discussion of ethical dilemmas and reflection of one's own learning. Every user - student, nurse supervisor or teacher - could choose her or his own pseudonym. AIM: The aim of this study was to describe how nursing students experience learning ethics with digital learning activity during clinical practice, how usable the Ethical Coffee Room platform is and how this learning activity should be developed further. RESEARCH DESIGN, PARTICIPANTS AND CONTEXT: The study employed a qualitative descriptive design and was an EU project between Finland, Sweden and Latvia. In total, 34 second-year nursing students participated in the study. The data collection methods were semi-structured interviews and written comments in the discussion forum Ethical Coffee Room. The data were analysed using content analysis. ETHICAL CONSIDERATIONS: Ethical approval and research permission were obtained from each partner organization, according to their national standards. FINDINGS: The results are presented under three themes: positive learning experiences of Ethical Coffee Room, challenges in learning during Ethical Coffee Room and practical suggestions for future development of Ethical Coffee Room. The results showed that the Ethical Coffee Room was experienced as a novel type of learning activity and an interesting way to learn ethics. DISCUSSION AND CONCLUSION: Ethical Coffee Room seems to be a promising learning activity enhancing students' ethical competence in clinical practice. However, active participation of the mentor nurses and teachers is essential. Therefore, mentor nurses and teachers need in-depth knowledge of ethical theories and concepts and how to apply them in clinical context.

Competence Assessment Instruments in Perianesthesia Nursing Care: A Scoping Review of the Literature.

PURPOSE: To identify competence assessment instruments in perianesthesia nursing care and to describe the validity and reliability of the instruments. DESIGN: A scoping review in a systematic manner. METHODS: A search in CINAHL, MEDLINE, and ERIC was carried out to identify empirical studies from 1994 to 2015. A narrative synthesis approach was undertaken to analyze the data. FINDINGS: Nine competence assessment instruments in perianesthesia nursing care were identified. The instruments used three types of data collection methods: Self-report, observation, and written examinations. The most commonly reported validity method was content validity involving expert panels and reliability tests for internal consistency and inter-rater's consistency. CONCLUSIONS: Integrating more than one data collection method may give support to overcoming some of the limitations, such as lack of objectivity and misinterpretation of the assessment results. In an ever-changing environment, perianesthesia nursing competence requires constant reassessment from the perspective of content validity, scoring methods, and reliability.

Seeing beyond monitors-Critical care nurses' multiple skills in patient observation: Descriptive qualitative study.

OBJECTIVES: The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. RESEARCH METHODOLOGY: Data from semi-structured interviews were analysed using thematic analysis. SETTING: Experienced critical care nurses (n=20) from three intensive care units in two university hospitals in Finland. FINDINGS: Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. CONCLUSION: This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses' competence evaluation.

Basic Competence of Intensive Care Unit Nurses: Cross-Sectional Survey Study.

Critical care patients benefit from the attention of nursing personnel with a high competence level. The aim of the study was to describe and evaluate the self-assessed basic competence of intensive care unit nurses and related factors. A cross-sectional survey design was used. A basic competence scale (Intensive and Critical Care Nursing Competence Scale version 1, Likert scale 1-5, 1 = poor and 5 = excellent) was employed among Finnish intensive care unit nurses (n = 431). Intensive care unit nurses' self-assessed basic competence was good (mean 4.19, SD 0.40). The attitude and value base of basic competence was excellent whereas experience base was the poorest compared to the knowledge base and skill base of intensive and critical care nursing. The strongest factor explaining nurses' basic competence was their experience of autonomy in nursing care (F value 60.85, ß 0.11, SE 0.01, and P ≤ 0.0001). Clinical competence was self-rated as good. Nurses gave their highest competence self-ratings for ICU patient care according to the principles of nursing care. The ICU nurses also self-rated their professional competence as good. Collaboration was self-rated as the best competence. In basic and continuing education and professional self-development discussions it is meaningful to consider and find solutions for how to improve nurses' experienced autonomy in nursing.

Evaluating adult patients' sleep: an integrative literature review in critical care.

BACKGROUND: Patients in a critical care unit sleep quite poorly even when they appear to be sleeping. Sleep is light and fragmented. Acute lack of sleep causes patients suffering in the form of fatigue, irritability, disorientation and hallucinations. It may also affect their recovery and immune defence. To promote sleep, nurses must be able to evaluate patients' sleep reliably. AIM AND OBJECTIVES: Our aim was to form a comprehensive overview of the sleep evaluation methods in critical care. Our objectives were to determine the content and the quality of the methods as reported by the researchers. This overview hopefully improves the use of the sleep evaluation methods as part of sleep promoting nursing interventions and practices. METHOD: The literature search was performed from the Ovid MEDLINE, CINAHL, an 'All EBM Reviews', and PsycINFO databases. The search terms sleep, evaluating sleep and critical care were used. An integrative review method was used to analyse the data. RESULTS: According to the 52 articles of this review, there is a wide variety of methods to evaluate patients' sleep in critical care by observation, by asking for patient's own perception and by objective measures. Most instruments evaluate only total sleep time or the quality of sleep in general. The validity and reliability of the instruments has been insufficiently reported. Some questionnaires for patients' perception have been tested and used in several studies. CONCLUSION: Sleep evaluation instruments do not cover all dimensions of sleep since they mostly measure total sleep time or estimate the overall quality of sleep. The quality of the sleep evaluation instruments varies from scientifically tested tools to untested instruments. This review will allow nurses to recognise the strengths and limitations of sleep evaluation instruments when selecting one to be used in critical care. Valid information about patients' sleep enables nurses to facilitate it.

Collaboration: a SWOT analysis of the process of conducting a review of nursing workforce policies in five European countries.

AIM: This paper critically reviews the literature on international collaboration and analyses the collaborative process involved in producing a nursing workforce policy analysis. BACKGROUND: Collaboration is increasingly promoted as a means of solving shared problems and achieving common goals; however, collaboration creates its own opportunities and challenges. Evidence about the collaboration process, its outcomes and critical success factors is lacking. METHODS: A literature review and content analysis of data collected from six participants (from five European countries) members of the European Academy of Nursing Science Scholar Collaborative Workforce Workgroup, using a SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis template. RESULTS: Two major factors affecting scholarly collaboration were identified: Facilitators, which incorporated personal attributes and enabling contexts/mechanisms, including individual commitment, responsibility and teamwork, facilitative supportive structures and processes. The second, Barriers, incorporated unmet needs for funding; time; communication and impeding contexts/mechanisms, including workload and insufficient support/mentorship. CONCLUSIONS: The literature review identified a low level of evidence on collaboration processes, outcomes, opportunities and challenges. The SWOT analysis identified critical success factors, planning strategies and resources of effective international collaboration. IMPLICATIONS FOR NURSING MANAGEMENT: Collaboration is an important concept for management. Evidence-based knowledge of the critical success factors facilitating and impeding collaboration could help managers make collaboration more effective.

Basic competence in intensive and critical care nursing: development and psychometric testing of a competence scale.

AIMS AND OBJECTIVES: To develop a scale to assess basic competence in intensive and critical care nursing. In this study, basic competence denotes preliminary competence to practice in an intensive care unit. BACKGROUND: There is a need for competence assessment scales in intensive care nursing practice and education. The nursing care performed in the intensive care unit is special by its nature and needs to be assessed as such. At this moment, however, there is no tested, reliable and valid scale in this field. DESIGN: A multi-phase, multi-method development and psychometric testing of the scale was conducted. METHODS: The scale was developed in three phases. First, following a literature review and Delphi study, the items were created. Second, the scale was pilot tested twice by nursing students (n1 = 18, n2 = 56) and intensive care nurses (n1 = 12, n2 = 54), and revisions were made. Third, reliability and construct validity were tested by graduating nursing students (n = 139) and intensive care nurses (n = 431). RESULTS: The Intensive and Critical Care Nursing Competence Scale (ICCN-CS-1) is a self-assessment test consisting of 144 items. Basic competence is divided into patient-related clinical competence and general professional competence. In addition, basic competence is comprised of knowledge base, skill base, attitude and value base and experience base. ICCN-CS-1 is a reliable and tolerably valid scale. CONCLUSIONS: The ICCN-CS-1 is a promising scale for use among nursing students and nurses. Future research is needed to evaluate its construct validity further and to assess its suitability for completion during intensive care unit's orientation programmes and nursing students' clinical practice in an intensive care unit. RELEVANCE TO CLINICAL PRACTICE: The ICCN-CS-1 can be used for basic competence assessment in professional development discussions in intensive care units, in mentor evaluation situations during nursing students' clinical practice and in intensive care nursing education.

Graduating nursing students' basic competence in intensive and critical care nursing.

AIMS AND OBJECTIVES: To describe and evaluate the basic competence of graduating nursing students in intensive and critical care nursing. BACKGROUND: Intensive and critical care nursing is focused on severely ill patients who benefit from the attention of skilled personnel. More intensive and critical care nurses are needed in Europe. Critical care nursing education is generally postqualification education that builds upon initial generalist nursing education. However, in Europe, new graduates practise in intensive care units. Empirical research on nursing students' competence in intensive and critical care nursing is scarce. DESIGN: A cross-sectional survey design. METHODS: A basic competence scale (Intensive and Critical Care Nursing Competence Scale, version 1) and a knowledge test (Basic Knowledge Assessment Tool, version 7) were employed among graduating nursing students (n = 139). RESULTS: Sixty-nine per cent of the students self-rated their basic competence as good. No association between self-assessed Intensive and Critical Care Nursing-1 and the results of the Basic Knowledge Assessment Tool-7 was found. The strongest factor explaining the students' conception of their competence was their experience of autonomy in nursing after graduation. CONCLUSION: The students seem to trust their basic competence as they approach graduation. However, a knowledge test or other objective method of evaluation should be used together with a competence scale based on self-evaluation. RELEVANCE TO CLINICAL PRACTICE: In nursing education and in clinical practice, for example, during orientation programmes, it is important not only to teach broad basic skills and knowledge of intensive and critical care nursing, but also to develop self-evaluation skills through the use of special instruments constructed for this purpose.

The transition from nursing student to registered nurse: the mentor's possibilities to act as a supporter.

The transition from nursing student to registered nurse can be exciting, stressful and challenging. It is common for nursing students to feel insecure about their competence and ability to step into working life. The role of the mentor in the final clinical practice is essential, as they guide students in their clinical learning process and professional growth. This study describes the mentor's support in the transition from nursing student to registered nurse. Sixteen nursing students wrote narrative essays about the significance of the clinical mentor in their role change in the transition process from nursing student to registered nurse. The essays were analysed using inductive content analysis. The findings show that the mentor has a significant role. Three main categories emerged in mentor's role: role change support, the mentor's actions and the qualities of the mentor. In future in clinical nursing practice, it is important to allocate resources to the mentor's work and understand its importance for nursing students' transition to nursing.

Competence requirements in intensive and critical care nursing--still in need of definition? A Delphi study.

BACKGROUND: Empirical studies in competence are lacking in the field of intensive and critical care nursing. OBJECTIVE: To identify competence requirements, by soliciting the views of intensive care unit nurses and physicians. METHODS: Two rounds of the Delphi method were used in 2006 in Finland. Data were analysed by content analysis and with descriptive statistics. RESULTS: Competence requirements in intensive and critical care nursing can be divided into five main domains: knowledge base, skill base, attitude and value base, nursing experience base and personal base of the nurse. Four of these domains can be found in the existing requirements and one new domain - personal base of the nurse - was identified. CONCLUSIONS: Competence requirements are multidimensional. Earlier descriptions of competence are not sufficient; more comprehensive and cohesive descriptions are needed. The personal base of a nurse should also be included in the competence requirements in intensive and critical care nursing.

A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom*/England.

AIM: Review nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and the United Kingdom*. BACKGROUND: Imbalances in registered nurse (RN) supply and demand is a global, significant and recurring issue that impacts on healthcare systems, organizations, staff and patients. METHOD: Policy Review using resources located by a systematic search of relevant healthcare databases and policies in Danish, English, Finnish and Portuguese over the time period 2003-2007. Content analysis was used to identify themes and compare policies. RESULTS: Common nursing workforce policy themes were identified across the five countries: (1) improving retention through effective human resource management, improving the practice environment and nurses' working lives and (2) improving recruitment through attracting more new recruits and RNs back to practice, and international recruitment. The present study also identified methodological issues relating to data quality and quantity. Lack of an agreed definition and standardized measures of nursing need and shortage makes comparison and evaluation of policy effectiveness and impact difficult. IMPLICATIONS FOR NURSING MANAGEMENT: Healthcare systems and organizations need to identify and implement effective policies that promote the retention of RNs in the workforce, or risk threats to healthcare system sustainability, as well as patient care quality and safety.