Assessment methods and tools to evaluate postgraduate critical care nursing students' competence in clinical placement. An integrative review.

AIM: To provide an overview of assessment methods and tools to evaluate postgraduate critical care nursing students' competence in clinical placement and to identify recommendations for future assessment methods. BACKGROUND: The purpose of postgraduate critical care nursing education is to educate professional, competent and caring critical care nurses and high-quality assessment strategies in clinical placement are of most importance. DESIGN: An integrative review following Whittemore and Knafl's framework and Prisma 2020 guidelines for systematic reviews. METHODS: Systematic searches were performed in June 2020 with an update in April 2021 using the following: Academic Search Premier, British Nursing Index, CINAHL, MEDLINE, SveMed+, Web of Science and the Joanna Briggs Institute databases. The systematic literature search and hand search yielded 380 studies. After screening and checking for eligibility, fifteen studies published between 2005 and 2020 were included in this review. The included studies were critically appraised using the Mixed Methods Appraisal Tool for empirical studies and the Joanna Briggs Institute Critical Appraisal tool for literature reviews. RESULTS: Four qualitative, six quantitative, three mixed-methods and two literature review studies were included in this review. We identified that competence in postgraduate critical care nursing is a multidimensional concept and it is recommended to use a combination of assessment methods like self-assessment, observation and mentor evaluation. It is necessary to have discussions and reflections between the student, preceptor and lecturer, as well as written self- and mentor evaluation to provide formative and summative feedback to the students. The need to provide consistency and objectivity resulted in the development of competency assessment tools and they were mostly developed and validated as a collaboration between clinical sites and educational institutions. Most of the assessment tools consisted of domains reflecting holistic nursing, including both technical and non-technical skills. Domains reflecting evidence-based nursing practice were less common. CONCLUSIONS: We need valid and reliable instruments to assess postgraduate critical care nursing student's competence in placement. Innovation and further research regarding effective and accessible assessment methods, such as digital assessment tools, are needed to meet future needs. This may also stimulate collaboration to improve the international inconsistency in critical care nursing educations. We should be working towards common, international educational competence descriptions and assessment tools that are in line with the ever-changing critical care environment, including holistic nursing and continuous learning.

How do Tanzanian hospital nurses perceive their professional role? A qualitative study.

AIM: To describe the experiences of Tanzanian nurses, how they perceive their role as a professional nurse and their experience with nursing care in a general hospital. DESIGN: This study is explorative, descriptive and qualitative. METHODS: The data were collected in 2015 by means of 10 semi-structured interviews and was analysed using qualitative content analysis. RESULTS: The data analysis revealed two themes with corresponding sub-themes related to Tanzanian nurses' perception with their professional role and experiences with nursing care: (1) Feeling professional pride; (2) Experiencing limitations and inadequacy. The findings indicate that the Tanzanian nurses possess a strong professional pride and commitment to serve and care for their patients. The nurses do their best to provide high -quality nursing care but are faced with staffing shortages and limited materials that are beyond their control. Such limitations leave them feeling unable to fulfil their role and responsibilities.

Shared Decision-Making-Balancing Between Power and Responsibility as Mental Health-Care Professionals in a Therapeutic Milieu.

BACKGROUND: Shared decision-making (SDM) is supposed to position patient and expert knowledge more equal, in which will have an impact on how mental health-care professionals relate to their patients. As SDM has not yet been widely adopted in therapeutic milieus, a deeper understanding of its use and more knowledge of interventions to foster its implementation in clinical practice are required. AIM: To explore how mental health-care professionals describe SDM in a therapeutic milieu as expressed through clinical supervision. The research question was "What are prerequisites for mental health-care professionals to practice SDM in a therapeutic milieu?" METHODS: A qualitative content analysis of data from focus groups dialogues in 10 clinical supervision sessions where eight mental health-care professionals participated was performed. FINDINGS: The theme, practicing SDM when balancing between power and responsibility to form safe care, was based on three categories: internalizing the mental health-care professionals' attributes, facilitating patient participation, and creating a culture of trust. CONCLUSION: SDM is a complex and arduous process requiring appropriate interventions. Clinical supervision is necessary for reflection on SDM and for improving practice in a therapeutic milieu.

Factors that influence user satisfaction: tracheotomised home mechanical ventilation users' experiences.

AIMS AND OBJECTIVES: To describe the self-reported life situation of users totally dependent on home mechanical ventilation (HMV) after tracheotomy and to identify factors associated with user satisfaction. BACKGROUND: HMV users are a small but growing group in society and among the most vulnerable individuals with chronic disabilities. The participants in the present study belong to an even more susceptible minority of this group, as they require round the clock ventilation at home through a tracheostomy, implying the need for continuous care. Their testimonies are important for the generation of new knowledge. DESIGN: A qualitative design using interviews. METHODS: Individual interviews were conducted with six participants and analysed by qualitative content analysis. RESULTS: The main theme that emerged different individual needs require a range of approaches was based on three sub-themes: (1) Tailored information (2) Sensitivity in decision-making and (3) Building trust and confidence. Information was perceived as crucial and participants described different experiences of receiving optimal information to not receiving information at all. Successful collaboration was perceived when the user was given the opportunity to participate in decision-making about her/his treatment and care, where to live and how to organise daily life. Trust and confidence in the caregivers were important. CONCLUSION: The participants highlighted the need for strategies to improve satisfaction. Their experiences varied depending on age, where they lived, who they encountered in the healthcare system and the level of family support. Our findings suggest that patients who perceive themselves as well informed at an early stage are more satisfied with treatment, decisions about their tracheotomy and their life situation. RELEVANCE TO CLINICAL PRACTICE: There is a lack of knowledge among healthcare providers, thus tailored, high competence and guidelines are required.

Patient experiences of uncertainty - a synthesis to guide nursing practice and research.

AIM: The aim of this study was to provide a synthesis of patients' experiences of uncertainty in illness and the interventions outlined, based on qualitative research. BACKGROUND: There is a need to explore various patient experiences from a nursing perspective in order to achieve evidence-based practice and improve the quality of care. Uncertainty in illness is a dynamic experience - a stressor with a major impact on patients' illnesses. METHODS: A literature search performed on PubMed and Cinahl yielded 15 qualitative studies that met the inclusion criteria and which were analysed and interpreted. RESULTS: Experienced uncertainty was one of two main areas comprising three themes: explaining, feeling and facing uncertainty. The second main area was suggested intervention strategies consisting of three themes: organizing the patient trajectory throughout the health-care system, supporting patients through relationships and providing knowledge through clear and accurate communication. CONCLUSION: Providing insight, confidence and supporting the patients' feeling of control are of importance for health-care professionals. IMPLICATIONS FOR NURSING MANAGEMENT: Structured organization of the trajectory system should be followed up, while outcome measures (patient satisfaction), education and training programmes for patients and families after discharge to improve coping strategies and reduce uncertainty should be developed. Nurse leaders should work towards the establishment of clinical academic nursing positions to integrate knowledge, skills, experiences and research into everyday routines.