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 [email protected]
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