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

28th International Networking for Healthcare Education Conference

NET2017 Conference Cambridge, 6 September 2017

Background

“Competence of a nurse

is a complex

combination of

knowledge, function,

skills, attitudes, and

values”.

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

B

• Novice/Advanced Beginner: marginally acceptable performance. He begins to identify clinical situation. 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. Critical, conscious and analytical competencies to understand the situation and to create plans.

E

• Proficient/Expert: intuitive understanding of each situation, able to evaluate 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

Novice/Advanced Beginner

Competent

Proficient/Expert

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

• 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.

E

• 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

Cardiology

• acute myocardial infarction

• heart failure

• atrial fibrillation

Paediatrics

• bronchiolitis

• sedation

• care for premature newborns

The matrix was based on a series of clinical cases identified by a panel of experts.

1° Step: from clinical case to matrix for categorizing the outcomes

Building matrix categorizing outcomes by Doran’s classification:

•Minimal nursing dataset;

•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

MATRIX

CATEGORIZING OUTCOMES

CLINICAL CASE

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 specific outcome proper validated tools have been

sought.

• For each identified outcome, the key competencies are

described.

• Each competence has been assigned a competency level

(B/C/E).

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.

• For each specific outcome proper validated tools have been

sought.

• Each competence has been assigned a competency level

(B/C/E).

2° Step: outcomes categorization

• For each specific outcome proper validated tools have been

sought.

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).

2° Step: outcomes categorization

• For each specific outcome proper validated tools have been

sought.

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).

2° Step: outcomes categorization

• For each specific outcome proper validated tools have been

sought.

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).

Matrix for categorizing the outcomes

Cardiology (N=22)

Paediatrics (N=19)

In this first phase of tool’s building some nurses from an Italian non specialist hospital are been involved.

63%

26%

11%

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

Recognizeanyalterationsofvitalsigns;

Recognizebronchiolitis

symptoms:

-Wheezing;

-Dyspnoea,

-Tachypnea;

-Hypoxemia;

-Intercostalretractions;

-Cyanosis;

-Lethargy;

-Feedingalterations.

Recordanychangeofsymptomsrightly,andassessthemaccording

tothegravity.

Implementmostappropriate

interventionstopreventworsening

ofsymptoms:

-Apnoea;

-Respiratorydistress;

-Respiratoryacidosis;

-Dehydration

ModifiedWood'sClinicalAsthma

Score(M-WCAS)

Duarte-

Dorado,2013)

Respiratory

AssessmentChange

Score(RACS)

RespiratoryDistress

ObservationScale

(M.L.Campbell,

2009)

B/

C/

E

B/

C/

E

Knowhowtodetectpain

andevaluateit.

Knowhowtomanagepain.

Effectivemanagementofpain

accordingtoage,conditionsand

child’scognitivedevelopment.

Correctuseofnon-pharmacological-

techniquestomanagepain

(distraction,breathing,relaxing,

bubbles,environment

management).

FLACC(Merkel

1997)

ComfortScale

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.

THANK YOU FOR YOUR ATTENTION For more information nicoletta.dasso@gmail.com