Development of clinical competencies for emergency nurse practitioners : a pilot study

Background: Nurse practitioner education and practice has been guided by generic competency standards in Australia since 2006. Development of specialist competencies has been less structured and there are no formal standards to guide education and continuing professional development for specialty fields. There is limited international research and no Australian research into development of specialist nurse practitioner competencies. This pilot study aimed to test data collection methods, tools and processes in preparation for a larger national study to investigate specialist competency standards for emergency nurse practitioners. Research into specialist emergency nurse practitioner competencies has not been conducted in Australia. Methods: Mixed methods research was conducted with a sample of experienced emergency nurse practitioners. Deductive analysis of data from a focus group workshop informed development of a draft specialty competency framework. The framework was subsequently subjected to systematic scrutiny for consensus validation through a two round Delphi Study. Results: The Delphi study first round had a 100% response rate; the second round 75% response rate. The scoring for all items in both rounds was above the 80% cut off mark with the lowest mean score being 4.1 (82%) from the first round. Conclusion: The authors collaborated with emergency nurse practitioners to produce preliminary data on the formation of specialty competencies as a first step in developing an Australian framework.

OSCE online : making assessment of clinical competencies transparent, accountable & authentic

Creating an authentic assessment which at once assesses competencies, scene management, communication and overall patient care is challenging in the competitive tertiary education market. Increasing student numbers and the cost of evaluating scenario based competencies serve to ensure the need for consistent objectivity and need for timely feedback to students on their performance. Objective structured clinical examination (OSCE) is currently the most flexible approach to competency based formative and summative assessment and widely used within paramedic degree programs. Students are understandably compelled to perform well and can be frustrated by not receiving timely and appropriate feedback. Increasingly a number of products aimed at providing a more efficient and paperless approach have begun to enter the market. These products, it is suggested are aimed at medicine programs and not at allied health professions and limited to one operating system and therefore ignore issues surrounding equity and accessibility. OSCE Online aims to address this gap in the market and is tailored to these disciplines. The application will provide a service that can be both tailored and standardised from a pre-written bank, depending upon requirement to fit around the needs of clinical competency assessment. Delivering authentic assessments to address student milestones in their training to become paramedics is the cornerstone of OSCE Online. By not being restricted to a specific device it will address issues of functionality, adaptability, accessibility, authenticity and importantly: transparency and accountability by producing contemporaneous data allowing issues to be easily identified and rectified.

Motivating undergraduate students via online learning to develop clinical competencies

Background: Online learning is becoming increasingly common for undergraduate health professions.Aims: To examine the effect of an online hypertension management module in motivating undergraduate pharmacystudents to further develop clinical competencies during future clinical placements.Method: The module focuses on approaches to counselling techniques for chronic disease management. It iscomplemented by therapeutics lectures, counselling tutorial and an objective structured clinical examination. A studentsurvey, constructed based on the Theory of Planned Behaviour, was undertaken after completion of the assessment.Results: Sixty two percent reported increased motivation to practice what they had learnt during placements, and amajority also reported improved attitudes and perceived self-efficacy. Levels of motivation had significant moderatecorrelations with improved appreciation of counselling techniques (r=0.489, p<0.001), and confidence to furtherpractice blood pressure counselling (r=0.411, p<0.001).Conclusion: Increased motivation to manage hypertension during future placements appears correlated with perceivedself-efficacy and engagement with the learning concepts.

Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Challenges for undergraduate speech pathology students undertaking cross-cultural clinical placements

Background: Two Australian undergraduate speech pathology students completed a series of clinical placements working with people with complex communication needs in cross-cultural contexts. Aims: To describe the challenges that the students faced and how best to prepare future students for such experiences. Methods & Procedures: The students completed the placements in Thailand, Nepal, Bangladesh, India and South Africa. They used personal journaling to record their experiences. The students used the journals as the basis for reflective discussion when considering the challenges they experienced in applying their knowledge and skills. Outcomes & Results: The challenges were (1) to prepare adequately ahead of the placements; (2) to select appropriate models of service delivery; (3) to use existing service approaches, resources and infrastructure appropriately; (4) to access professional support; (5) to define their professional role; (6) to manage variable shared language proficiency; (7) to adapt personally; and (8) to work using an undergraduate level of knowledge, skills and experience. Conclusions: The students encountered challenges related to their clinical preparation and their capacity to adapt in both a professional and personal sense. Future students preparing to undertake such placements need to attain at least minimum clinical competencies before placements. They will be helped if they have some clinical experience in working with people with complex communication needs in cross-cultural contexts, information about the cultures they will visit, and if they set professional and personal learning goals for each clinical placement. This preparation will aid students in maximizing their learning experience.

Planning nursing teaching: Educational purposes and clinical competence

Thinking about nursing education implies articulating this issue with the expressions of theoretical frameworks, from the perspective of a pedagogical aspect that includes both constructivism and competencies. The objective was to characterize, from a longitudinal view, the construction of care competencies that exist in the teaching plans of nursing undergraduate programs. This exploratory-descriptive study used a qualitative approach. Documentary analysis was performed on the nine teaching plans of undergraduate care subjects. The ethical-legal aspects were guaranteed, so that data was collected only after the study had been approved by the Research Ethics Committee. The data evidenced a curriculum organization centered on subjects, maintaining internal rationales that seem to resist summative organizations. Signs emerge of hardly substantial links between any previous knowledge and the strengthening of critical judgment and clinical reasoning. As proposed, the study contributed with reconsiderations for the teachinglearning process and showed the influence of constructivism on the proposal of clinical competencies.

Competencies Needed By Mental Health Professionals Working With Parents of Children With Asthma

This paper describes clinical competencies necessary for mental health professionals working with parents of children with Asthma. Seven highly accomplished mental health clinicians from the Pediatric Behavioral Health Department at the nationally ranked hospital, National Jewish Health in Denver, Colorado were interviewed about the competencies they feel are needed to work with this specific population. The results of these interviews are organized into knowledge, skills and attitudes. Recommendations for other mental health providers are provided.

Measuring nursing competencies in the operating theatre: instrument development and psychometric analysis using Item Response Theory

BACKGROUND: Concern about the process of identifying underlying competencies that contribute to effective nursing performance has been debated with a lack of consensus surrounding an approved measurement instrument for assessing clinical performance. Although a number of methodologies are noted in the development of competency-based assessment measures, these studies are not without criticism. RESEARCH AIM: The primary aim of the study was to develop and validate a Performance Based Scoring Rubric, which included both analytical and holistic scales. The aim included examining the validity and reliability of the rubric, which was designed to measure clinical competencies in the operating theatre. RESEARCH METHOD: The fieldwork observations of 32 nurse educators and preceptors assessing the performance of 95 instrument nurses in the operating theatre were used in the calibration of the rubric. The Rasch model, a particular model among Item Response Models, was used in the calibration of each item in the rubric in an attempt at improving the measurement properties of the scale. This is done by establishing the 'fit' of the data to the conditions demanded by the Rasch model. RESULTS: Acceptable reliability estimates, specifically a high Cronbach's alpha reliability coefficient (0.940), as well as empirical support for construct and criterion validity for the rubric were achieved. Calibration of the Performance Based Scoring Rubric using Rasch model revealed that the fit statistics for most items were acceptable. CONCLUSION: The use of the Rasch model offers a number of features in developing and refining healthcare competency-based assessments, improving confidence in measuring clinical performance. The Rasch model was shown to be useful in developing and validating a competency-based assessment for measuring the competence of the instrument nurse in the operating theatre with implications for use in other areas of nursing practice.

Enhancing paramedics procedural skills using a cadaveric model

Background Paramedic education has evolved in recent times from vocational post-employment to tertiary pre-employment supplemented by clinical placement. Simulation is advocated as a means of transferring learned skills to clinical practice. Sole reliance of simulation learning using mannequin-based models may not be sufficient to prepare students for variance in human anatomy. In 2012, we trialled the use of fresh frozen human cadavers to supplement undergraduate paramedic procedural skill training. The purpose of this study is to evaluate whether cadaveric training is an effective adjunct to mannequin simulation and clinical placement. Methods A multi-method approach was adopted. The first step involved a Delphi methodology to formulate and validate the evaluation instrument. The instrument comprised of knowledge-based MCQs, Likert for self-evaluation of procedural skills and behaviours, and open answer. The second step involved a pre-post evaluation of the 2013 cadaveric training. Results One hundred and fourteen students attended the workshop and 96 evaluations were included in the analysis, representing a return rate of 84%. There was statistically significant improved anatomical knowledge after the workshop. Students' self-rated confidence in performing procedural skills on real patients improved significantly after the workshop: inserting laryngeal mask (MD 0.667), oropharyngeal (MD 0.198) and nasopharyngeal (MD 0.600) airways, performing Bag-Valve-Mask (MD 0.379), double (MD 0.344) and triple (MD 0.326,) airway manoeuvre, doing 12-lead electrocardiography (MD 0.729), using McGrath(R) laryngoscope (MD 0.726), using McGrath(R) forceps to remove foreign body (MD 0.632), attempting thoracocentesis (MD 1.240), and putting on a traction splint (MD 0.865). The students commented that the workshop provided context to their theoretical knowledge and that they gained an appreciation of the differences in normal tissue variation. Following engagement in/ completion of the workshop, students were more aware of their own clinical and non-clinical competencies. Conclusions The paramedic profession has evolved beyond patient transport with minimal intervention to providing comprehensive both emergency and non-emergency medical care. With limited availability of clinical placements for undergraduate paramedic training, there is an increasing demand on universities to provide suitable alternatives. Our findings suggested that cadaveric training using fresh frozen cadavers provides an effective adjunct to simulated learning and clinical placements.

Preparing to prescribe: How do clerkship students learn in the midst of complexity?

Prescribing tasks, which involve pharmacological knowledge, clinical decision-making and practical skill, take place within unpredictable social environments and involve interactions within and between endlessly changing health care teams. Despite this, curriculum designers commonly assume them to be simple to learn and perform. This research used mixed methods to explore how undergraduate medical students learn to prescribe in the 'real world'. It was informed by cognitive psychology, sociocultural theory, and systems thinking. We found that learning to prescribe occurs as a dynamic series of socially negotiated interactions within and between individuals, communities and environments. As well as a thematic analysis, we developed a framework of three conceptual spaces in which learning opportunities for prescribing occur. This illustrates a complex systems view of prescribing education and defines three major system components: the "social space", where the environmental conditions influence or bring about a learning experience; the "process space", describing what happens during the learning experience; and the intra-personal "cognitive space", where the learner may develop aspects of prescribing expertise. This conceptualisation broadens the scope of inquiry of prescribing education research by highlighting the complex interplay between individual and social dimensions of learning. This perspective is also likely to be relevant to students' learning of other clinical competencies.

¿Impactó el programa de Tutores Pares a sus tutores?

Introducción: El programa de Tutores Pares-TP es una iniciativa creada en la EMCS de la Universidad del Rosario que brinda acompañamiento académico a través de estudiantes-tutores a pares menos avanzados. Éste entrega a sus Tutores sistemáticamente, herramientas para desempeñarse armónicamente en el ejercicio de guía y provee habilidades para el manejo del saber. Este estudio busca explorar posibles ´impactos´ generados tras la participación de estudiantes de medicina como TPs dentro de un programa estructurado. Materiales y métodos: Estudio cualitativo que involucró la construcción y aplicación de encuestas a grupos focales –TPs, Docentes y Familiares- creadas a partir de seis ejes/categorías que enmarcan al médico ideal. Las respuestas obtenidas de preguntas cerradas –en escala valorativa- y de naturaleza abierta fueron sometidas a análisis descriptivo –modas- y triangulación. Resultados: 41 tutores, agrupados en 4 grupos de análisis, evidenciaron un impacto general positivo con predominio en habilidades interpersonales (60%,65%,66%,45%, respectivamente), funciones/actividades basadas en la práctica y mejoramiento (57%,67%,60%,45%) y la forma como se emplean los conocimientos (47%,70%,67%,48%). Ocho docentes encuestados consideraron relevante el impacto del programa en habilidades interpersonales-(49%), conocimientos-(42%) y la interacción con colegas-(38%). En los padres de familia hay consenso en el cambio en habilidades interpersonales, funciones basadas en la práctica y mejoramiento y en actitudes-valores ético/morales. Dichos resultados están en paralelo con las observaciones plasmadas en las preguntas abiertas. Conclusiones: Se evidenció un impacto general positivo en la formación y desempeño profesional tras la participación como TPs dentro del programa; hallazgo que soporta aquellos publicados de experiencias académicas similares.

Informe final creación y evaluación de campo de un instrumento para la medición de las competencias clínicas en Fisioterapia

La evaluación de los procesos formativos en el área clínica, basados en competencias, es fundamental para la Fisioterapia. Este proceso articula la teoría con la práctica, orienta la organización de los procesos académicos, promueve la formación integral y establece mecanismos de retroalimentación permanentes y rigurosos, basados en la evaluación del desempeño del profesional en formación ante situaciones del día a día que dan cuenta de su toma de decisiones profesional. Se espera que los estudiantes se formen y puedan actuar como profesionales competitivos a nivel nacional e internacional, de manera integral, con sólidos compromisos éticos y sociales para responder a las necesidades del entorno social en el que se desenvuelven (PEP, Universidad del Rosario). Los esfuerzos actuales en investigación de la evaluación educativa se encuentran orientados a la integración de la adquisición del conocimiento y al desarrollo de estrategias de medición y cuantificación de capacidades técnico-científicas dentro de cada disciplina. En este sentido, hasta el momento, en Colombia no se encuentra evidencia alrededor de la validación de instrumentos de medición de las competencias clínicas, ni se cuenta con estándares para la evaluación en práctica clínica en el proceso de formación del recurso humano en Fisioterapia. En el proyecto se desarrolló y fueron evaluadas las propiedades psicométricas de un instrumento que mide las competencias clínicas del estudiante de fisioterapia en la práctica clínica. Este proceso involucró a Fisioterapeutas que con experiencia en el área de docencia y clínica, contribuyen con la formación de fisioterapeutas en Colombia.

The role of supervision in the training of a psychoanalyst

This paper discusses the role of clinical supervision in psychoanalytic training. It also discusses the impact of training modes on the psychoanalytic organisations that use these different models of training. The paper argues that psychoanalytic training consists of a unique combination of personal analysis, study of psychoanalytic theory and research and clinical supervision. Given the variation of these three components and their possible interactions, an overly prescriptive view of training can be detrimental and counterproductive. The effectiveness of psychoanalytic supervision is to a significant degree dependent upon a trainee being engaged in personal analysis. Clinical competency requires extensive clinical experience obtained in a variety of settings and with a broad exposure to patient groups. The detrimental implications of restrictive and reductive views on psychoanalytic training that seek to specify quantitative criteria rather than clearly articulate clinical competencies are discussed.

Occupational therapy cluster /

Project staff: Joseph A. Bonefeste, Kathryn Torricelli, Patricia Johnson.--P. [2] of cover.