Anaesthesia nursing competence: Self-assessment of nursing students.

BACKGROUND: The importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers. OBJECTIVES: To assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care. DESIGN: Cross-sectional survey design. METHODS: Data from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0-100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data. RESULTS: The self-assessed overall competence of graduating nursing students was 59 (range 43-73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence. CONCLUSIONS: Competence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.

Students' Self-assessed Competence Levels during Nursing Education Continuum - A Cross-sectional Survey.

During nursing education, nursing students are required to develop their competence to be able to fulfill their duties safely as Registered Nurses. The aims of this study were to explore 1) nursing students' self-assessed competence levels during education 2) the relationship with competence and frequency at which competencies are utilized in clinical practice, and 3) factors related to competence levels. 841 (response rate 67.6 %) nursing students responded to the Nurse Competence Scale in a cross-sectional study. The self-assessed overall competence levels were improving during the education continuum (VAS-means 1st 56.6; 2nd 58.3; 3rd 59.8 and 3.5th -year students 68.4). Every group revealed a significant positive correlation with competence and frequency at which competencies are utilized in clinical practice in clinical placement. Risk factors for low competence were also identified. Systematic multimethod competence evaluations with longitudinal designs are needed to monitor outcomes of nursing education.

Developing and psychometric testing of the anaesthesia nursing competence scale.

RATIONALE, AIMS, AND OBJECTIVES: The competence of nurses in anaesthesia care is important for the quality of anaesthesia nursing care and patient safety. However, there is a lack of psychometrically tested instruments to measure the competence. Therefore, this study aimed to develop and test the psychometric properties of an anaesthesia nursing competence scale (AnestComp) assessing nurses' competence in anaesthesia care. METHOD: The scale development and psychometric testing had three phases: (1) based on literature reviews and the description of experts, competence areas were identified and items were created; (2) the content validity of the scale was tested by a content expert group, and the scale was pilot tested; and (3) psychometric testing of scale was tested by anaesthesia nurses' (n = 222) and nursing students' (n = 205) self-assessments. The psychometric testing assessed the reliability when using Cronbach's α and the construct validity using factor analyses (confirmatory and exploratory) and known-group technique. Nursing students were included for the purpose of construct validity testing. RESULTS: The AnestComp has 39 items and consists of seven competence areas: (a) ethics of anaesthesia care, (b) patient's risk care, (c) patient engagement with technology, (d) collaboration within patient care, (e) anaesthesia patient care with medication, (f) peri-anaesthesia nursing intervention, and (g) knowledge of anaesthesia patient care. Cronbach's α values were high in all categories (0.83-0.95), and factor analyses and known-group technique supported a seven-factor model. CONCLUSION: The initial results supported the reliability and construct validity of the AnestComp. The scale is considered a promising instrument for measuring anaesthesia nursing competence among anaesthesia nurses. Further research with larger and more diverse samples is suggested to refine the current psychometric evaluation.

Expectations of patients with colorectal cancer towards nursing care- a thematic analysis.

PURPOSE: The purpose of this study was to explore comprehensively expectations of patients with colorectal cancer towards nursing care in the chemotherapy context. METHODS: A purposive sample of patients with colorectal cancer (n = 15) was interviewed individually at the outpatient clinic in one university hospital chemotherapy unit. The data were analysed with thematic analysis. RESULTS: Three main themes were identified in the data. Firstly, patients expected to be empowered with knowledge of disease process, side effects and their self-management and peer support. Secondly, patients expected to be humanely encountered, which included being encountered with support, compassion and hope. Thirdly, patients expected to be skillfully cared for with systematic assessment, expertise, continuity and advocacy. CONCLUSIONS: Besides reliable knowledge of cancer treatment and care, patients expected the sympathetic presence of a nurse whose professional skills they can trust. The results may be utilised in intervention development by focusing on themes significant to these patients. The results may help nurses to enhance person-centred care as well as to encounter patients according to their expectations.

Evidence-informed policymaking: Modelling nurses' career pathway from registered nurse to advanced practice nurse.

AIM: To formulate, validate, and disseminate policy, modelling nurses' career pathway from registered to advanced practice nurse. METHOD: The evidence-informed policy and practice pathway framework was utilized. Multiple methods were used, including scoping review of literature, consultation of key informants, survey study, and expert group round-table discussions during 5-year project between 2013 and 2018. RESULTS: Through (a) sourcing, (b) using, and (c) implementing the evidence, the expert group worked systematically to formulate a policy on a career pathway from registered to advanced practice nurse. The formulated career pathway includes three competence levels: registered nurse, specialized nurse, and advanced practice nurse, which includes the roles of nurse practitioner and clinical nurse specialist. In addition, validation and dissemination of the policy, as well as its effective implementation and the process of integrating it into practice, were examined. CONCLUSION: Evidence-informed policymaking is an effective, interactive way to work collaboratively in achieving consensus and translating knowledge into practice. The formulated policy will contribute to the increased awareness, acknowledgement, and implementation of the registered nurses' traditional and new roles within health care environments. Implementing and integrating the policy in national health care policy, legislation, education, and organizations across the country is a work in progress.

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews.

AIMS AND OBJECTIVES: To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions. BACKGROUND: Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence. METHODS: This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data. RESULTS: The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue. CONCLUSIONS: Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions. RELEVANCE TO CLINICAL PRACTICE: Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment.

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

RATIONAL: The 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. OBJECTIVES: To describe the formulation and validation process of the clinical nurse specialist core competencies. DESIGN: Exploratory sequential mixed-method design. METHODS: This mixed-method study, conducted between 2013 and 2017 in Finland, involved four phases: I) a Policy Delphi study (n = 25, n = 22, n = 19); II) cross-mapping of preliminary competency criteria against international competency sets; III) content validity study of expanded competency criteria (n = 7, n = 10); and IV) verification of competency criteria with practicing CNSs (n = 16). Data were analysed by both qualitative and quantitative analysis methods. RESULTS: Seventy-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. CONCLUSIONS: Through 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.

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

AIMS: The 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. BACKGROUND: For 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. DESIGN: A parallel-group randomized controlled trial. METHODS: Data were collected between January-March 2015 in Finland. The nursing students were randomly allocated to an intervention group (N = 52) or control group (N = 50). 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. RESULTS: Competence and self-efficacy showed no significant between-group differences in mean improvements, but significant improvements in both groups were detected over the 5 weeks. 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. CONCLUSION: The mobile cooperation intervention was not significantly effective in improving individual outcomes, but did seem to improve significantly some aspects of the contextual outcomes. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT02635295.

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

AIM: To identify existing orientation patterns and to find elements that may enhance or impede successful orientation of newly graduated nurses. BACKGROUND: Preceptors have first-hand information concerning orientation and their opinions should not be forgotten when organisations develop their orientation processes. METHOD: An open-ended questionnaire was undertaken to collect data from preceptors (n = 172) about the current orientation patterns. Data were analysed by using deductive content analysis and by quantifying the phrases. RESULTS: Communal 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 organisation's structural and functional problems were the impeding elements of successful orientation. CONCLUSIONS: With 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. IMPLICATION FOR NURSING MANAGEMENT: Nurse 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.

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.

Development of Nurses' Professional Competence Early in Their Career: A Longitudinal Study.

BACKGROUND: Research on newly graduated nurses' competence development and associated factors is relatively scarce. METHOD: Data for this longitudinal, descriptive, correlation study were collected during 2012-2014 from 318 Finnish nurses to explore their competence development during the first 3 years after graduation and to estimate the extent to which given work-related factors predicted change in competence. Data were analyzed using NCSS 10 statistical software. RESULTS: Nurses' initially fairly high level of competence showed an increase in the third year, as measured by the Nurse Competence Scale. Empowerment increased minimally, whereas perceptions of practice environment, ethical climate, and occupational commitment decreased. Willingness to leave the profession and dissatisfaction with current job and nursing profession increased. Empowerment, satisfaction with current job and quality of care, time from graduation, and work experience explained 25.6% of the change in competence. CONCLUSION: Competence development was modest but increasing. Willingness to leave the profession was concerning. Factors enhancing or preventing competence development need further studying and developing proactive interventions. J Contin Educ Nurs. 2017;48(1):29-39.

Nurse Competence Scale: a systematic and psychometric review.

AIM: The aim of this study was to report a systematic and psychometric review. BACKGROUND: The 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. DESIGN: A systematic literature review of research evidence and psychometric properties. DATA SOURCES: Nine databases from 2004 - October 2015. REVIEW METHODS: We 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. RESULTS: A 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. CONCLUSION: The 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.

BACKGROUND: Although 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. METHODS: A descriptive, cross-sectional and correlational design was applied. The sample comprised newly graduated nurses (n = 318) 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. RESULTS: Newly 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. CONCLUSIONS: New 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.

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.

Evaluating clinical competence during nursing education: A comprehensive integrative literature review.

This paper explored concepts, definitions and theoretical perspectives evaluating clinical competence during nursing education. The questions were: (i) How is clinical competence evaluated? and (ii) What is evaluated? An integrative review of 19 original research articles from 2009 to 2013 was performed. Results showed that evaluation tools were used in 14, observations in 2 and reflecting writing in 3 studies. The students participated in all but one evaluation alone or together with peers, faculty members or preceptors. Three themes were found: (i) professional practice with a caring perspective; (ii) clinical skills and reflective practice; and (iii) cognitive, affective and psychomotor skills both with a nursing perspective. This review shows an emphasis on structured methods with a risk reducing nursing to tasks and skills why combinations with qualitative evaluations are recommended. A holistic view of competence dominated and in designing evaluations, explicit perspectives and operationalized definitions of clinical competence became evident.

Newly graduated nurses' occupational commitment and its associations with professional competence and work-related factors.

AIMS AND OBJECTIVES: To explore newly graduated nurses' occupational commitment and its associations with their self-assessed professional competence and other work-related factors. BACKGROUND: As a factor affecting nurse turnover, newly graduated nurses' occupational commitment and its associations with work-related factors needs exploring to retain adequate workforce. Nurses' commitment has mainly been studied as organisational commitment, but newly graduated nurses' occupational commitment and its association with work-related factors needs further studying. DESIGN: This study used descriptive, cross-sectional, correlation design. METHODS: A convenience sample of 318 newly graduated nurses in Finland participated responding to an electronic questionnaire. Statistical software, NCSS version 9, was used in data analysis. Frequencies, percentages, ranges, means and standard deviations summarised the data. Multivariate Analyses of Variance estimated associations between occupational commitment and work-related variables. IBM SPSS Amos version 22 estimated the model fit of Occupational Commitment Scale and Nurse Competence Scale. RESULTS: Newly graduated nurses' occupational commitment was good, affective commitment reaching the highest mean score. There was a significant difference between the nurse groups in favour of nurses at higher competence levels in all subscales except in limited alternatives occupational commitment. Multivariate analyses revealed significant associations between subscales of commitment and competence, turnover intentions, job satisfaction, earlier professional education and work sector, competence counting only through affective dimension. CONCLUSION: The association between occupational commitment and low turnover intentions and satisfaction with nursing occupation was strong. Higher general competence indicated higher overall occupational commitment. RELEVANCE TO CLINICAL PRACTICE: Managers' recognition of the influence of all dimensions of occupational commitment in newly graduated nurses' professional development is important. Follow-up studies of newly graduated nurses' commitment, its relationship with quality care, managers' role in enhancing commitment and evaluation of the impact of interventions on improving commitment need further studying.

Practice environment and its association with professional competence and work-related factors: perception of newly graduated nurses.

AIM: To explore newly graduated nurses' (NGN) perception of their practice environment and its association with their self-assessed competence, turnover intentions and job satisfaction as work-related factors. BACKGROUND: The impact of practice environment on nurses' work is important. Positive practice environments are associated with positive organisational, nurse and patient outcomes. How this applies to NGNs needs further exploration. METHOD: A cross-sectional descriptive correlation design was used. Data were collected with PES-NWI and NCS instruments from 318 Finnish registered nurses, and analysed statistically. RESULTS: Newly graduated nurses' perception of their practice environment was mainly positive. Most positive perceptions related to collegial nurse-physician relations, and the least positive to staffing and resource adequacy. Positive perceptions were also associated with higher professional competence, higher perceptions of quality of care and lower intentions to leave the job or profession. CONCLUSION: The findings revealed strong and significant associations between practice environment and work-related factors. Practice environment is an important element in supporting NGNs' competence, retention and job satisfaction. Nursing management should pay attention to NGNs' perceptions of their practice environment. IMPLICATIONS FOR NURSING MANAGEMENT: Management's ability to create and maintain positive practice environments can foster NGNs' professional development and job satisfaction, and consequently retain them in the workforce.

Newly Graduated Nurses' Competence and Individual and Organizational Factors: A Multivariate Analysis.

OBJECTIVE: To study the relationships between newly graduated nurses' (NGNs') perceptions of their professional competence, and individual and organizational work-related factors. METHODS: A multivariate, quantitative, descriptive, correlation design was applied. Data collection took place in November 2012 with a national convenience sample of 318 NGNs representing all main healthcare settings in Finland. Five instruments measured NGNs' perceptions of their professional competence, occupational commitment, empowerment, practice environment, and its ethical climate, with additional questions on turnover intentions, job satisfaction, and demographics. Descriptive statistics summarized the demographic data, and inferential statistics multivariate path analysis modeling estimated the relationships between the variables. RESULTS: The strongest relationship was found between professional competence and empowerment, competence explaining 20% of the variance of empowerment. The explanatory power of competence regarding practice environment, ethical climate of the work unit, and occupational commitment, and competence's associations with turnover intentions, job satisfaction, and age, were statistically significant but considerably weaker. Higher competence and satisfaction with quality of care were associated with more positive perceptions of practice environment and its ethical climate as well as higher empowerment and occupational commitment. CONCLUSIONS: Apart from its association with empowerment, competence seems to be a rather independent factor in relation to the measured work-related factors. Further exploration would deepen the knowledge of this relationship, providing support for planning educational and developmental programs. Research on other individual and organizational factors is warranted to shed light on factors associated with professional competence in providing high-quality and safe care as well as retaining new nurses in the workforce. CLINICAL RELEVANCE: The study sheds light on the strength and direction of the significantly associated work-related factors. Nursing professional bodies, managers, and supervisors can use the findings in planning orientation programs and other occupational interventions for NGNs.

Anaesthesia nursing education in the Nordic countries: Literature review.

OBJECTIVES: The 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. METHODS: A 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. RESULTS: The Nordic countries have different types of post-registration anaesthesia nursing education from non-degree supplementary programmes to Master's 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. CONCLUSION: This 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 country's educational system.

The future of the clinical nurse specialist role in Finland.

PURPOSE: To identify and examine the expert panelists' visions on the future implementation of the clinical nurse specialist (CNS) role in Finland. DESIGN AND METHODS: A policy Delphi design was conducted in 2013. A purposive sampling method was used to recognize expert panelists in the areas of advanced practice nursing (APN), healthcare management, and advanced practice nurse education. Three iterative Web-based survey rounds were conducted (n = 25, n = 22, n = 19). Both qualitative and quantitative methods were used to analyze the data. FINDINGS: The expert panelists envisioned the future of the CNS role in Finland. This study portrayed the CNS role in Finland as generally consistent with the international role. CNS have comprehensive skills and knowledge that they use to guide and develop nursing practice; however, several threats may affect their role achievement. The existing national consensus, contradiction, and ambivalence related to CNS roles were revealed through the examination of the results, thus pointing out the areas for consideration when further developing these roles and role policies. CONCLUSIONS: This is the first national study to examine the implementation of the CNS role in Finland. Expert panelists' views regarding the CNS role will be valuable in the forthcoming national policy formulation process. Although the policy Delphi design is not often utilized, this study reveals that it is very well suited to guide and inform national and international APN policy development. CLINICAL RELEVANCE: This study contributes to CNS role development and describes the methods facilitating the essential policy formulation process.