ASSESSMENT AND EVALUATION OF ADVANCED CLINICAL COMPETENCE NURSE CLINICAL COMPETENCE SCALE (NCCS) NURSE COMPETENCE SCALE (NCS) Presented by: Anna-Lena Nieminen,

ASSESSMENT AND EVALUATION OF ADVANCED CLINICAL

COMPETENCENURSE CLINICAL COMPETENCE

SCALE (NCCS)NURSE COMPETENCE SCALE (NCS)

Presented by: Anna-Lena Nieminen, RN, PHN, MSc, Doctoral studentSvenska Yrkeshögskolan / Health Care and Social Welfare. Department of Caring Science Faculty of Social and Caring Sciences, Åbo Akademi University, Vasa Finland.Supervisor: Lisbeth Fagerström, RN, PhD, DeanSvenska Yrkeshögskolan / Health Care and Social Welfare, Vasa Finland.

CONTENT

1. Educational Programme for Nurse Practitioners in Finland

2. Assessment and Evaluation of Advanced Clinical Competence / Instruments

A. Nurse Competence Scale

B. Nurse Clinical Competence Scale

3. Investigation group

4. Data collection

5. Data analysis

6. Preliminary Results

7. Summary

ProficientChronic and acute diseases (60 cr)

Advance clinical skills

Evidence based practice and critical thinking

Pharmacology

Probing and identifying caring needs

AdvanceChronic and acute diseases (90 cr) => master level

Advance clinical skills and physical assessment

Evidence based practice and critical thinking

Health promotion (theoretical models )

Probing and identifying caring needs

Nursing research methods

Educational Programme for Nurse Practitioners in Finland

AIMThe purpose of this study is to measure advanced clinical competences, by describing professional skills while comparing three groups with different educational and working background.

Instruments for assessment and evaluation of advanced clinical competence

A. Nurse Clinical Competence Scale (Nieminen & Fagerström 2005)

B. Nurse Competence Scale (Meretoja 2004)

Nurse Competence Scale, Meretoja 2004

• Nurses self-assessment of competence • 73-item instrument (of clinical indicators)• VAS-scale 0-100 mm(visual analogue scale)• 4-point scale (0= not applicable in my work, 1= used

very sheldom, 2=used occasionally and 3= used very often

Derived from Benner´s theory: from novice to expert• Categories: Helping role(7 items), Teaching-coaching

(16items), Diagnostic functions (7 items), Managing situations (8 items), Therapeutic interventions (10 items) and Work (professional) role (19 items)

Nurse Clinical Competence Scale,Nieminen & Fagerström 2005 (unpubliched material)

• Nurses self-assessment of clinical competence • 65-item instrument (of clinical indicators)• VAS-scale 0-100 mm(visual analogue scale)• 4-point scale (0= not applicable in my work,

1= used very sheldom, 2=used occasionally and 3= used very often

• Interdisciplinary framework: caring- and nursing science, natural sciences, psychology etc.

Nurse Clinical Competence Scale

• Based on ICN:s definition of Nurse Practitoners i.e: the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice

Exampel of items to be assessed:- I take responsibibility for my own actions- I work independently- I am systematic in my way of working- I am self critical about my way of working- I conduct physical assessment of the patient- I have independent responsibility for the examination, care and treatment

of patients with complicated- and uncomplicated illness- I provide individual advice on health promotion and illness prevention to

the patient, taking national recommendations into consideration- I take active responsibility for my own professional development

The Background

Investigation group

R.N students in Nurse Practitioners program,

n= 19

R.N working with proficient tasks within primary health care, n= 37

R.N working with proficient tasks within health care at the hospital , n= 28

Data

• Instruments

- NCS and NCCS

• Theme-related additional questions- How do you describe your clinical competence?

- How do you develope and maintain your clinical competence

- What is the meaning of responsibility for you in your own work setting?

AGE

Age N range SD mean

a) Students,

AP

17 27-49 6,32 39,8

b) Nurses in primary health care

35 28-60 8,04 46,9

c) Nurses in hospital settings

26 28-61 8,08 45,01

P=.009

Work experience in years

Work experience

N range SD mean

a)Students,

NP

18 4-23 5,88 12,8

b)Nurses in primary health care

37 5-38 9,18 22,3

c)Nurses in hospital settings

28 4-34 7,51 19,4

P=.033

Background Information

38,90 %

24,30 %

37,90 %

5,60 %

10,30 %10,80 %

5,60 %3,40 %

17,20 %

32,40 %

0 %

5 %

10 %

15 %

20 %

25 %

30 %

35 %

40 %

45 %

a) Students NP(n=18)

b) Nurses inprimary health

care (n=37)

c) Nurses inhospital

settings (n= 28)

Internal medicine andoperative

Public health

Pediatric

Interdisciplinary

Others

Specialization

Background InformationAcademic studies

66,70 %

78,40 %

41,40 %

5,60 %

29,70 %

10,30 %

22,20 %

27,00 %

31,00 %

0 % 20 % 40 % 60 % 80 % 100 %

studies

a)Students(ANP)

b)Nurses

PrimaryHealth

c)Nurses

SpecialistHealth care

Caring/nursing Science Health care adminsitration Other

Data analysis

• Statistics

-Descriptive

-Anova test

• Content analysis

NCCS

8,5

9,2

9,1

1,81

0,82

0,61

0 2 4 6 8 10

a)Student (ANP)(n=18)

b)Primary health care nurses(n=37)

c)Special health care nurses(n=28)

Std.dev.

Mean

F=3,258 (d.f.=2;80);p=.044

The statement: I am acting independently

NCCS p< .05

Acting independently F=3,25 (d.f.=2;80); p= .044

Mean a) 8,5 b) 9,2 c) 9,1

Making own decisons F=3,790 (d.f.=2;80); p= .027

Mean a) 8,4 b) 9,3 c) 8,7

Preventing medical problems

F= 5,79 (d.f.=2;80); p= .004

Mean a) 5,9 b) 8,1 c) 8,2

Providing individual advice on health promotion and illness prevention

F=4,08 (d.f.=2;80); p= .004

Mean a) 6,1 b) 8,4 c) 8,4

a) Students b) Nurses in primary health care c) Nurses in hospital settings

NCS p< .05

Mapping out patients education needs carefully

F=2,91(d.f.=2;81);p=.060

Mean a) 7,0 b) 6,9 c) 8,2

Recognizing family members´ needs for guidande

F=3,74 (d.f.=2;81);p=.028

Mean a) 7,7 b) 5,9 c) 6,7

Arranging expert help for patient when needed

F=5,94(d.f.=2;81);p=.004

Mean a) 6,3 b) 8,2 c) 8,0

Utilising nursing research findings in relationship with patients

F=2,91(d.f.=2;81);p=.060

Mean a) 5,7 b) 4,9 c) 6,3

a) Students b) Nurses in primary health care c) Nurses in hospital settings

NCCS

7,9 7,38

3,042,13 2,52

0 0,3 0,7

9,8 10 10

6,86

0

2

4

6

8

10

12

Mean Std.dev. Min. Max

The statement: ”I am coherent in compiling information

concerning the state of the patients illness and health resourses. ”

F=1,122 (d.f.=2;80); p= .331

NCCS

5,64,4 4,38

3,05 2,97 3,03

9,8 10 9,7

02468

1012

Mean Std.dev. Min. Max

F=1,091 (d.f.=2;78); p=.341

The statement:”I create and utlize clinical strategies based on evidense based practice”

NCCS

8,388,95 8,63

1,14 0,93 1,02

9,9 10 9,8

0

2

4

6

8

10

12

a)Students(n=18)

b)Primaryhealth

carenurses

(n=37) c)Specialist

health

carenurses

(n=28)

Mean Std.dev. Min. Max

F=2,023 (d.f.=2;80); p=.139

The statement: I reflect on my actions

Preliminay results from the theme related questions

1. Organizational

2. Educational

3. Role and professionalism

4. Caring for the patient as the ”source to work”

Responsibility is:

Caring in responsibility

Limitate Freedom

Lonely Independence

Scaring Tempting and Challenging

Burdensome Pleasant

Summary

1. Useful instruments for assessing clinical competence

2. Describes the competence level of the investigation groups

3. Longitudinal studies

4. Prefering one of the tools (NCCS or NCS)

5. The main aspect of caring where related to the inner dimension of responsibility