Competence in intensive and critical care nursing - development of a basic assessment scale for graduating nursing students

Intensive and critical care nursing is a speciality in its own right and with its own nature within the nursing profession. This speciality poses its own demands for nursing competencies. Intensive and critical care nursing is focused on severely ill patients and their significant others. The patients are comprehensively cared for, constantly monitored and their vital functions are sustained artificially. The main goal is to win time to cure the cause of the patient’s situation or illness. The purpose of this empirical study was i) to describe and define competence and competence requirements in intensive and critical care nursing, ii) to develop a basic measurement scale for competence assessment in intensive and critical care nursing for graduating nursing students, and iii) to describe and evaluate graduating nursing students’ basic competence in intensive and critical care nursing by seeking the reference basis of self-evaluated basic competence in intensive and critical care nursing from ICU nurses. However, the main focus of this study was on the outcomes of nursing education in this nursing speciality. The study was carried out in different phases: basic exploration of competence (phase 1 and 2), instrumentation of competence (phase 3) and evaluation of competence (phase 4). Phase 1 (n=130) evaluated graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care with Basic Knowledge Assessment Tool version 5 (BKAT-5, Toth 2012). Phase 2 focused on defining competence in intensive and critical care nursing with the help of literature review (n=45 empirical studies) as well as competence requirements in intensive and critical care nursing with the help of experts (n=45 experts) in a Delphi study. In phase 3 the scale Intensive and Critical Care Nursing Competence Scale (ICCN-CS) was developed and tested twice (pilot test 1: n=18 students and n=12 nurses; pilot test 2: n=56 students and n=54 nurses). Finally, in phase 4, graduating nursing students’ competence was evaluated with ICCN-CS and BKAT version 7 (Toth 2012). In order to develop a valid assessment scale of competence for graduating nursing students and to evaluate and establish the competence of graduating nursing students, empirical data were retrieved at the same time from both graduating nursing students (n=139) and ICU nurses (n=431). Competence can be divided into clinical and general professional competence. It can be defined as a specific knowledge base, skill base, attitude and value base and experience base of nursing and the personal base of an intensive and critical care nurse. Personal base was excluded in this self-evaluation based scale. The ICCN-CS-1 consists of 144 items (6 sum variables). Finally, it became evident that the experience base of competence is not a suitable sum variable in holistic intensive and critical care competence scale for graduating nursing students because of their minor experience in this special nursing area. ICCN-CS-1 is a reliable and tolerably valid scale for use among graduating nursing students and ICU nurses Among students, basic competence of intensive and critical care nursing was self-rated as good by 69%, as excellent by 25% and as moderate by 6%. However, graduating nursing students’ basic biological and physiological knowledge and skills for working in intensive and critical care were poor. The students rated their clinical and professional competence as good, and their knowledge base and skill base as moderate. They gave slightly higher ratings for their knowledge base than skill base. Differences in basic competence emerged between graduating nursing students and ICU nurses. The students’ self-ratings of both their basic competence and clinical and professional competence were significantly lower than the nurses’ ratings. The students’ self-ratings of their knowledge and skill base were also statistically significantly lower than nurses’ ratings. However, both groups reported the same attitude and value base, which was excellent. The strongest factor explaining students’ conception of their competence was their experience of autonomy in nursing. Conclusions: Competence in intensive and critical care nursing is a multidimensional concept. Basic competence in intensive and critical care nursing can be measured with self-evaluation based scale but alongside should be used an objective evaluation method. Graduating nursing students’ basic competence in intensive and critical care nursing is good but their knowledge and skill base are moderate. Especially the biological and physiological knowledge base is poor. Therefore in future in intensive and critical care nursing education should be focused on both strengthening students’ biological and physiological knowledge base and on strengthening their overall skill base. Practical implications are presented for nursing education, practice and administration. In future, research should focus on education methods and contents, mentoring of clinical practice and orientation programmes as well as further development of the scale.

Rymättylän ja Merimaskun yleissuunnitelma : Rantojen monikäyttö, luonnon monimuotoisuus, kosteikot ja suojavyöhykkeet

Naantalissa, Rymättylän ja Merimaskun alueella tehtiin kesällä ja syksyllä 2015 maatalousalueiden kosteikkojen, suojavyöhykkeiden ja luonnon monimuotoisuuskohteiden sekä ranta-alueiden monikäytön yleissuunnitelma. Ranta-alueiden suunnittelussa tarkastellaan ranta-alueiden monikäyttöä ja arvioidaan erityisesti ruovikoihin liittyviä toimenpiteitä. Suunnittelun tavoitteena oli löytää potentiaalisia rantaniittyjä ja ruovikoita hoi-don piiriin. Maatalousalueiden yleissuunnittelussa tuodaan näkyväksi alueet, joilla luonnon monimuotoisuutta tai vesien tilaa voidaan kohentaa. Suunnitelmassa on selvitetty alueen suojavyöhyketarpeet, esitetty maata-louskosteikkojen perustamispaikkoja sekä tuotu esille luonnon ja maiseman monimuotoisuuskohteita sekä perinnebiotooppeja. Ranta-alueiden monikäytön yleissuunnittelun kohteena olivat ranta-alueet Rymättylän pohjoisosassa ja Merimaskun länsiosan alueella. Maatalousalueiden kosteikkojen, suojavyöhykkeiden ja luonnon monimuotoisuus-kohteiden yleissuunnittelu kattaa Rymättylän pohjoisosan lisäksi Airismaan sekä Aaslaluodon. Monimuotoisuusalueiden, kosteikkojen ja suojavyöhykkeiden kartoitukset pohjautuivat ProAgria Suomen Talousseuran aikaisempiin tarvekartoitushavaintoihin, joita tehtiin hankkeen Tasapainoa luontoon aikana vuosina 2010–2014. Kartoituksen yhteydessä tarkasteltiin myös Turun AMK:n Niukonlahden vesiensuojeluohjelmaa 2013. Suunnitelmalla pyritään auttamaan viljelijää hyödyntämään maatalouden ympäristökorvausjärjestelmää. Kohteiden maininta suunnitelmassa ei sido eikä velvoita maanomistajaa toimenpiteisiin vaan yleissuunnitelman tietoja voidaan hyödyntää kohteiden kunnostusta ja hoitoa suunniteltaessa.

Kotona asuvien iäkkäiden monilääkitys sekä psyyken- ja kipulääkkeiden käyttö

Summary: Polypharmacy and the use of psychotropics and analgesic drugs among the community-dwelling elderly

Rouva Anna-Liisa Vaurola 18/9 1973

Kirje 18.9.1973

Maisteri Ritva-Liisa Sumu 9/12 1974

Kirje 9.12.1974