28th International Networking for Healthcare Education Conference Self assessment of nursing competencies: a tool appropriate for various clinical areas N. Dasso, A. Bagnasco, M. Barisone, G. Aleo, M. Zanini, G. Catania, L. Sasso NET2017 Conference Cambridge, 6 September 2017
Competence of a nurse is a complex combination of knowledge, function, skills, attitudes, and values. Background
Background Nursing knowledge about disease management varies greatly and it is often based on direct clinical experience rather than on specially designed educational courses. But some international scientific associations begin to deepen the nurse s role.
Background In the paediatric field attention is still focused on identifying nursing skills to create proper education.
Background
Aim The purpose of this study was to develop a conceptual model of reference that provides a framework for nursing competencies in specific clinical areas and a tool that enables nurses to self- assess their competencies.
Method In line with other studies on competencies in the field of cardiology and paediatrics, we identified the knowledge and the skills required to ensure safe practice for each learning objective.
Building of Competencies Matrix Following the Heart Failure Clinical Competence Model we have built the clinical competencies matrix: Assessment Symptoms Prognosis Disease management
Competency level We created and tested a tool for the self-assessment of competencies formulated according to the theoretical model developed by Benner. She applied the model and extended the Dreyfus model of Skill Acquisition to explain the progression a nurse makes from novice practitioner to clinical expert. Benner P. From novice to expert: excellence and power in clinical nursing practice. Menlo Park, CA: Addison-Wesley; 1984
3 Competency levels B Novice/Advanced Beginner: marginally acceptable performance. He begins Novice/Advanced to identify clinical situation. Beginner Unable to have entirety comprehensive view of a new clinical case. Absence of critical approach. C Competent: aware of all relevant aspects of a situation; able to see his or her actions in terms of medium and long-range goals or plans. Competent Critical, conscious and analytical competencies to understand the situation and to create plans. E Proficient/Expert: intuitive understanding of each situation, able to evaluate Proficient/Expert and intervene in an accurate and rational manner on the problem; he works with a deep knowledge of the situation as a whole. Highly skilled, he uses analytic tools when a new situation presents.
3 Competency levels B Novice/Advanced Beginner: marginally acceptable performance. They begin to identify clinical situations. They are unable to have entirety comprehensive view of a new clinical case and the absence of critical approach. C E Competent: they are aware of all relevant aspects of a situation; they are able to see their actions in terms of medium and long-range goals or plans. They have critical, conscious and analytical competencies to understand the situation and to create plans. Proficient/Expert: intuitive understanding of each situation, they are able to evaluate and intervene in an accurate and rational manner on the problem; they work with a deep knowledge of the situation as a whole. Highly skilled, they use analytic tools when a new situation presents itself.
Method The matrix was based on a series of clinical cases identified by a panel of experts. Cardiology acute myocardial infarction heart failure atrial fibrillation Paediatrics bronchiolitis sedation care for premature newborns
1 Step: from clinical case to matrix for categorizing the outcomes Building matrix categorizing outcomes by Doran s classification: Minimal nursing dataset; CLINICAL CASE MATRIX CATEGORIZING OUTCOMES Symptoms management; Managing adverse events; Patient safety; Mortality; Psychological suffering; Quality of life; Patient safety/ satisfaction; Self-care. Nursing Outcomes: The State of the Sciences D.M. Doran, 2011
2 Step: outcomes categorization Competency Level Key competence Specific outcome Validated tools Each principal outcome is reflected in specific outcome depending on the case being considered. For each identified outcome, the key competencies are described. Each competence has been assigned a competency level (B/C/E). For each specific outcome proper validated tools have been sought.
2 Step: outcomes categorization Key competence Specific outcome Validated tools Each principal outcome is reflected in specific outcome depending on the case being considered. For each identified outcome, the key competencies are described. Each competence has been assigned a competency level (B/C/E). For each specific outcome proper validated tools have been sought.
2 Step: outcomes categorization Key competence Specific outcome Validated tools Each principal outcome is reflected in specific outcome depending on the case being considered. For each identified outcome, the key competencies are described. Each competence has been assigned a competency level (B/C/E). For each specific outcome proper validated tools have been sought.
2 Step: outcomes categorization Key competence Specific outcome Validated tools Each principal outcome is reflected in specific outcome depending on the case being considered. For each identified outcome, the key competencies are described. Each competence has been assigned a competency level (B/C/E). For each specific outcome proper validated tools have been sought.
2 Step: outcomes categorization Key competence Specific outcome Validated tools Each principal outcome is reflected in specific outcome depending on the case being considered. For each identified outcome, the key competencies are described. Each competence has been assigned a competency level (B/C/E). For each specific outcome proper validated tools have been sought.
Matrix for categorizing the outcomes In this first phase of tool s building some nurses from an Italian non specialist hospital are been involved. Cardiology (N=22) Paediatrics (N=19) 11% 26% 63% Nurses expert in Pediatrical Area Nurses expert in Neonatological Area Chief nursing
2 Step: outcomes categorization In the second phase, the categorization matrix has been tested on some nurses from an Italian non specialist hospital. 63 nurse experts in the Medical and Cardiology field; 52 nurse experts in the Paediatric field.
Example of outcome categorization Heart Failure
Symptom management B/ C/ E Recognizing heart failure symptoms: dyspnoea, cyanosis, orthopnoea, ascites, declivous oedemas, jugular turgor and fatigue. Record any symptom changes and implement most appropriate interventions to prevent worsening of symptoms. Symptom Distress Scale (Rhodes, 1998) Profile of Mood States (POMS) (McNair, 1981) Lee Fatigue Scale (K. Lee, 1991) Dyspnoea Index Self-care B/ C/ E Health promotion and interventions aimed at treating the disease. Achieve changes in behaviour and daily life habits that adhere to treatment plan. Exercise of Self Care Agency Scale (Kearny,1979) Herat Failure Self-Care Behaviour Scale (Jaarsma et al, 1999) Self-Care Assessment Tool (Johannsen, 1992)
Competencies required to take care a patient affected by heart failure
Example of outcome categorization Bronchiolitis in Infant
Symptoms management B/ C/ E Recognize any alterations of vital signs; Recognize bronchiolitis symptoms: -Wheezing; - Dyspnoea, - Tachypnea; - Hypoxemia; - Intercostal retractions; - Cyanosis; Record any change of symptoms rightly, and assess them according to the gravity. Implement most appropriate interventions to prevent worsening of symptoms: -Apnoea; -Respiratory distress; -Respiratory acidosis; -Dehydration Modified Wood's Clinical Asthma Score (M-WCAS) Duarte- Dorado,2013) Respiratory Assessment Change Score (RACS) Respiratory Distress Observation Scale (M.L. Campbell, 2009) -Lethargy; - Feeding alterations. B/ C/ E B/ C/ E Know how to detect pain and evaluate it. Know how to manage pain. Effective management of pain according to age, conditions and child s cognitive development. Correct use of non-pharmacologicaltechniques to manage pain (distraction, breathing, relaxing, bubbles, environment management). FLACC (Merkel 1997) Comfort Scale
Competencies required to take care an infant affected by bronchiolitis
Work in progress 3 Step: self-assessment tool for nursing skills Nursing Competence Scale 1. Taking over responsibilities (7 item) 2. Education Skills (16 item) 3. Diagnostic skills (7 item) 4. Management skills (8item) 5. Therapeutic interventions (10 item) 6. Ensure quality (6 item) 7. Covered position (19 item)
Conclusion There is global consensus on the need for continued education in the field of healthcare, but there is still debate on how to improve the way this is provided. Monitoring the process of competence acquisition is still complex. There are various experiences in this field, but a globally accepted model is still missing. The tool for the self- assessment of competencies is useful to keep track of the clinical competencies gained by cardiac and paediatric nurses. This tool is important because it can be used in a multidisciplinary context that globally cares for patients and their families.
Conclusion The availability of a tool for professionals to self-assess their competencies enables them to constantly and contextually monitor the quality of the care they provide, adopting appropriate strategies also for the implementation of self-care, for which specific competencies are necessary according to the type of patient and pathology. The clinical case was structured in order to facilitate the standardization of the self-assessment process of the competencies and therefore the possibility for professionals to identify whether they had educational technical, gestural or relational gaps.
Conclusion The tool for the self- assessment of competencies is useful to keep track of the clinical competencies gained by cardiac and paediatric nurses. This tool is important because it can be used in a multidisciplinary context that globally cares for patients and their families.
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