ASSESSMENT AND EVALUATION OF ADVANCED CLINICAL COMPETENCE NURSE CLINICAL COMPETENCE SCALE (NCCS) NURSE COMPETENCE SCALE (NCS) Presented by: Anna-Lena Nieminen, RN, PHN, MSc, Doctoral student Svenska 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, Dean Svenska Yrkeshögskolan / Health Care and Social Welfare, Vasa Finland.

CONTENT Educational Programme for Nurse Practitioners in Finland Assessment and Evaluation of Advanced Clinical Competence / Instruments Nurse Competence Scale Nurse Clinical Competence Scale 3. Investigation group Data collection 5. Data analysis 6. Preliminary Results 7. Summary

Educational Programme for Nurse Practitioners in Finland Proficient Chronic and acute diseases (60 cr) Advance clinical skills Evidence based practice and critical thinking Pharmacology Probing and identifying caring needs Advance Chronic and acute diseases (90 cr) => master level Advance clinical skills and physical assessment Health promotion (theoretical models ) Nursing research methods

AIM The 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 Nurse Clinical Competence Scale (Nieminen & Fagerström 2005) Nurse Competence Scale (Meretoja 2004) Assessing the advanced clinical competence of practising clinical nurses in different work settings (environment) is imprtant for tex. Identifying areas for professional development and educational needs and also to making sure that nurse competencies are put to the best possible use in patient care and also a garanty for nusrses to maintain their advanced clinical competence. NCS was chosen because it has proven a high validity and reability to meassure nurses competence, especially in the area of specialist health care. When the educational programme for nurse practitioner started at Swedish Polytechninc, we found out that we needed an other instrument that has the ability to measure specific competencies and skills, i.e ; autonomous desicion making and problem solving skills.

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) Each item is rated by using a VAS o-100 with the opposite ends labelled O meaning a very low level and 100 meaning a very high level of competence. The frequency with individual items are actually used in clinical practice is indicated on a fourpoint scale

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 The Background 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 Exampel of statements to be assessed

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? Data were collected by......

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 Notera att i grupp a finns enbart en man, likaså i grupp c och ingen i grupp b.

Work experience in years 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

Background Information Specialization

Background Information Academic studies

Data analysis Statistics -Descriptive Content analysis -Anova test (obtained by empirical study using SPSS) All data were entered into a computer database and analyzed using SPSS 10.1. Significance was set at P <0.05. Descriptive statistics. And Anova test was used (analys of variance). Anova pga att man inte är begränsad till två jämförelse grupper, utan man kan ha flera. Får fram skillnader och motsättningar hos data. Det finns dels en inom grupp skillnad och en mellan grupp skillnad. Descriptive statistics (obtained by empirical study using SPSS) Content analysis ( obtained by the team categories/classification rose after analyzing the results at the first part) ( obtained by the team categories/classification rose after analyzing the results at the first part The methods of data annalysis used were coding, category identifaction and pattern recontion

NCCS The statement: I am acting independently F=3,258 (d.f.=2;80);p=.044

NCCS p< .05 Acting independently Making own decisons a) Students b) Nurses in primary health care c) Nurses in hospital settings 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   P= in group a) .050 b) .799 c) .759 P= in group a) .009 b) .379 c) .243 P= in group a) .088 b) .173 c) .529 P= in group a) .070 b) .709 c) .146

NCS p< .05 Mapping out patients education needs carefully a) Students b) Nurses in primary health care c) Nurses in hospital settings 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 Mean a) 5,7 b) 4,9 c) 6,3 2/4 har signifikanta skillnader p= in group a) .162 b) .615 c) .559 P= in group a) .542 b) .520 c) .776 P= in group a) .001 b) .427 c) .072 P= in group a) .539 b) .347 c) .385

NCCS The statement: ”I am coherent in compiling information concerning the state of the patients illness and health resourses. ”   P in group a) .364 b) .796 c) .786 F=1,122 (d.f.=2;80); p= .331  

NCCS The statement:”I create and utlize clinical strategies based on evidense based practice” P= in group a) .165 b) .568 c).487 F=1,091 (d.f.=2;78); p=.341  

NCCS The statement: I reflect on my actions Bra resultat att alla verkar vara reflekterande vårdare P= in group a) .569 b) .433 c) .461 F=2,023 (d.f.=2;80); p=.139

Preliminay results from the theme related questions Responsibility is: Organizational Educational Role and professionalism Caring for the patient as the ”source to work”

Caring in responsibility Limitate Freedom Lonely Independence Scaring Tempting and Challenging Burdensome Pleasant

Summary Useful instruments for assessing clinical competence Describes the competence level of the investigation groups Longitudinal studies Prefering one of the tools (NCCS or NCS) The main aspect of caring where related to the inner dimension of responsibility Reflect om my actionsTest which evaluation tools are better suited for measuring advanced clinical competence verb är borta