Lifelong learning in community healthcare: Testing competence after learning activities in a blended learning space.

AIMS AND OBJECTIVES: This study reports from a municipality in Norway that implemented a competence enhancement programme for all its institutional nursing staff during the COVID-19 pandemic to fill identified competence gaps. BACKGROUND: Many Norwegian municipalities are experiencing a demand for expanded community healthcare services due to an increase in elderly patients and patients with extensive and complex needs. At the same time, most municipalities are striving to recruit and keep competent health personnel. New ways of organising and increasing the competence of the workforce may help ensure that the healthcare delivered corresponds to patients' changing needs. DESIGN AND METHODS: Nursing staff were encouraged to complete targeted competence enhancing activities with the aim of enhancing their competence in identified areas. The learning activities were blended and consisted of e-learning courses, lectures, supervision, vocational training and meetings with a superior. Competence was measured before and after the competence enhancing activities (n = 96). The STROBE checklist was applied. RESULTS: The results provide insight into the competence development of registered nurses and assistant nurses in institutional community health services. They show that the implementation of a workplace-based blended learning programme improved competence significantly, especially for assistant nurses. CONCLUSIONS: Offering workplace-based competence enhancing activities seems to be a sustainable way of facilitating lifelong learning among nursing staff. Facilitation of learning activities in a blended learning space may enhance accessibility and increase the potential for participation. A combination of reorganisation of roles and simultaneous competence enhancing activities can ensure that both managers and nursing staff prioritise filling competence gaps.

Educating for Excellence: A Cohort Study on Assessing Student Nurse Anesthetist Non-Technical Skills in Clinical Practice.

Non-technical skills play an integral role in providing safe and excellent anesthesia. Currently there is little standardization in the assessment of non-technical skills in clinical practice, although various instruments exist. The aim of this study was to explore the use of the Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no) structured assessment instrument in developing and assessing non-technical skills in clinical practice. This cohort study had a longitudinal design. Twenty student nurse anesthetists' nontechnical skills were assessed by their mentors (N=31) and clinical supervisors (N=7) at three time-points over a 12-month period, after providing anesthesia to a patient. A 5-point rating scale was used for both the experts' assessments and students' self-assessments. Development of non-technical skills over time was estimated using linear mixed-effect models. The students demonstrated a significant overall development of non-technical skills (P<.001), achieving an expert assessment of 4.5 at the end of their education. The students significantly underestimated their clinical performance compared with the experts' assessments (P<.001). The structured behavioral assessment instrument appears to be reliable for assessing student nurse anesthetists' non-technical skills in clinical practice. This study may have implications for systematic assessment of non-technical skills in Norway and other countries.

The Ms. Olsen test: Measurement properties of a short test of nursing staffs' competence in clinical decision-making.

AIMS: To assess the measurement properties of the Ms. Olsen test for registered nurses and assistant nurses, respectively, and suggest cut-off points between competence levels. DESIGN: Cross-sectional study. The results were analysed by implementing the Rasch Measurement Theory. METHODS: Nursing staff working in various health care settings participated (n = 757). To measure the competence of nursing staff in clinical decision-making, a 19-item scale from the Nursing Older People-Competence Evaluation Tool-the 'Ms. Olsen test'-was used. Data were collected in October 2017, 2018 and 2019. RESULTS: The Ms. Olsen test showed reasonably good measurement properties for registered nurses and assistant nurses respectively. Results show slightly better measurement properties for registered nurses than for assistant nurses. The cut-off for registered nurses, 0.62, corresponds to managing approximately two-thirds of the items while, for assistant nurses, the cut-off of 0.01 corresponds to managing approximately half of the items. CONCLUSION: The Ms. Olsen test is a short (7- to 10-min) test measuring competence in clinical decision-making among nursing staff working in older people nursing. Despite reasonably good measurement properties, this should be considered an initial validation in the development of a short test for assessing clinical decision-making among nursing staff in various health care setting. IMPACT: Several scales aiming to measure nursing competence have been developed over the last decade, but measurement properties (beyond classical test theory) are seldom evaluated, few scales concern other staff groups than registered nurses and few scales have proposed or established cut-offs for safe practice. The Ms. Olsen test is a short test of clinical decision-making that demonstrates reasonably good measurement properties. Cut-off points for registered nurses and assistant nurses were established. The Ms. Olsen test may be used to measure and evaluate competence in clinical decision-making among nursing staff working in older people nursing and educational settings.

Psychometric Testing of a Structured Assessment Instrument for Non-technical Skills (NANTS-no) for Use in Clinical Supervision of Student Nurse Anesthetists.

BACKGROUND: This study evaluated psychometric properties of a structured behavioral assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no). It estimated whether reliable assessments of nontechnical skills (NTS) could be made after taking part in a workshop. An additional objective was to evaluate the instrument's acceptability and usability. METHODS: An explorative design was used. Nurse anesthetists (n = 46) involved in clinical supervision attended a 6-hour workshop on NTS, then rated NTS in video-recorded simulated scenarios and completed a questionnaire. RESULTS: High reliability and dependability were estimated in this setting. Participants regarded the instrument as useful for clinical supervision of student nurse anesthetists (SNAs). CONCLUSIONS: Findings suggest that NANTS-no may be reliable for performing clinical assessments of SNAs and encouraging critical reflection. However, further research is needed to explore its use in clinical settings.

The Objective Structured Clinical Examination in evolving nurse practitioner education: A study of students' and examiners' experiences.

Assessment of advanced clinical competence is essential for safe practice and achieving international standards for nurse practitioners. It is of particular interest for countries that have recently been introduced to advanced nursing roles to investigate examination forms that ensure quality in nurse practitioner education. The aim of this study was to explore and describe the nurse practitioner students' and examiners' experiences with Objective Structured Clinical Examination, which is an exam form for assessing clinical competence. Five focus groups, consisting of 15 nurse practitioner students (n = 15) and five individual interviews with examiners (n = 5), were conducted in June 2016 and analysed using thematic analysis. The nurse practitioner students and examiners experienced the exam as an appropriate method of assessment for advanced clinical competence, although they experienced some challenges with its form. Consequently, the results of this study advocate for a course design that includes: constructive alignment between the course and the exam, more training with real patients, use of formative and summative assessment and a second exam with a real patient after the student's clinical placement. The lack of a clear nurse practitioner role in countries with evolving advanced nursing roles can challenge the expected level of advanced clinical competence in an educational context.

Risk for delivery complications in Robson Group 1 for non-Western women in Norway compared with ethnic Norwegian women - A population-based observational cohort study.

OBJECTIVES: To assess the pregnancy outcome of low-risk pregnancies for women originating from non-Western countries compared with ethnic Norwegian women. STUDY DESIGN: A retrospective population-based observational cohort study with prospectively registered data. Conducted at Stavanger University Hospital, Norway, with approximately 4800 deliveries annually, from 2009 to 2015. We included women with low-risk pregnancies of non-Western origin (n = 1413), born in Africa (n = 224), Asia (n = 439), Eastern Europe (n = 499), Middle East (n = 138), South America (n = 85), Western (n = 979), and ethnic Norwegian women (n = 7028). MAIN OUTCOME MEASURES: The relative risk of emergency cesarean section or postpartum hemorrhage by country of origin was estimated by odds ratios with 95% confidence intervals using logistic multiple regression. RESULTS: In total, the pregnancy outcomes of 9392 women were analyzed. Risk of emergency cesarean section was significantly higher for women originating from Asia (aOR: 1.887), followed by Africans (aOR: 1.705). Lowest risk was found in women originating from South America (aOR: 0.480). Risk of postpartum hemorrhage was significantly higher in women originating from Asia (aOR: 1.744) compared to Norwegians. CONCLUSION: Even in a low-risk population, women originating from Asia and Africa had an elevated risk of adverse pregnancy outcome compared to the Norwegian group. The elevated risk should be considered by obstetric care providers, and we suggest that women originating from Asia and Africa would benefit from a targeted care during pregnancy and childbirth.

Norwegian translation, cultural adaption and testing of the Person-centred Practice Inventory - Staff (PCPI-S).

BACKGROUND: Person-centred health care has widespread recognition, but there are few instruments aimed at measuring the provision of person-centred practice among health care professionals across a range of settings. The Person-centred Practice Inventory - Staff (PCPI-S) is a new instrument for this purpose, theoretically aligned with McCormack & McCance's person-centred framework, which has been translated and culturally adapted into Norwegian. METHODS: The study used a two-stage research design involving: translation and cultural adaption of the PCPI-S from English to Norwegian language (phase 1), and a quantitative cross sectional survey following psychometric evaluation (phase 2). Confirmatory factor analysis was used to examine the theoretical measurement model. RESULTS: The translation and cultural adaption was carried out according to ten recommend steps. Discrepancies were addressed and revised by all translators until consensus was reached on a reconciled version of the translation. A sample of 258 health care staff participated in the survey. The model fit statistics were overall positive; the model requires minor modifications and these are mostly confined to correlated errors. CONCLUSIONS: The translation and cultural adaption process of the PCPI-S from English to Norwegian language was a demanding process in order to retain the conceptual meanings of the original instrument. Overall, the psychometric properties of the tool were acceptable, but testing on a larger sample size is recommended.

ETHICS OF SMART HOUSE WELFARE TECHNOLOGY FOR OLDER ADULTS: A SYSTEMATIC LITERATURE REVIEW.

BACKGROUND: The University College of Southeast Norway has an on-going project to develop a smart house welfare system to allow older adults and people with disabilities to remain in their homes for as long as they wish in safe, dignified, living conditions. OBJECTIVES: This article reviews reported ethical challenges to implementing smart houses for older adults. METHODS: A systematic literature review identified twenty-four articles in English, French, Spanish, and Norwegian, which were analyzed and synthesized using Hofmann's question list to investigate the reported ethical challenges. RESULTS: Smart houses offer a promising way to improve access to home care for older adults and people with disabilities. However, important ethical challenges arise when implementing smart houses, including cost-effectiveness, privacy, autonomy, informed consent, dignity, safety, and trust. CONCLUSIONS: The identified ethical challenges are important to consider when developing smart house systems. Due to the limitations of smart house technology, designers and users should be mindful that smart houses can achieve a safer and more dignified life-style but cannot solve all the challenges related to ageing, disabilities, and disease. At some point, smart houses can no longer help persons as they develop needs that smart houses cannot meet.

Sufficient competence in community elderly care? Results from a competence measurement of nursing staff.

BACKGROUND: Multi-morbidity, poly-pharmacy and cognitive impairment leave many old patients in a frail condition with a high risk of adverse outcomes if proper health care is not provided. Knowledge about available competence is necessary to evaluate whether we are able to offer equitable and balanced health care to older persons with acute and/or complex health care needs. This study investigates the sufficiency of nursing staff competence in Norwegian community elderly care. METHODS: We conducted a cross-sectional survey of 1016 nursing staff in nursing homes and home care services with the instrument "Nursing Older People - Competence Evaluation Tool". Statistical analyses were ANOVA and multiple regression. RESULTS: We found that nursing staff have competence in all areas measured, but that the level of competence was insufficient in the areas nursing measures, advanced procedures, and nursing documentation. Nursing staff in nursing homes scored higher than staff in home care services, and older nursing staff scored lower than younger nursing staff. CONCLUSIONS: A reason for the relatively low influence of education and training on competence could be the diffuse roles that nursing staff have in community elderly care, implying that they have poor standards against which to judge their own competence. Clearer role descriptions for all groups of nursing staff are recommended as well as general competence development in geriatric nursing care.

Nursing older people-competence evaluation tool: development and psychometric evaluation.

BACKGROUND AND PURPOSE: To evaluate the quality of care provided to older people, the competence of the nursing staff must be measured. This study evaluates a new instrument called Nursing Older People-Competence Evaluation Tool (NOP-CET). METHODS: A 65-item questionnaire was completed by 1,016 community-based nursing staff and evaluated for validity, reliability, precision, interpretability, acceptability, and feasibility. RESULTS: The survey demonstrated good content validity; conceptually coherent factor structure explaining 54.98% (knowledge items), 65.03% (skills items), and 52.83% (personal attribute items) of the total variance; and internal consistency (.77-.93). CONCLUSIONS: The NOP-CET showed good validity and reliability as a measure of community-based nursing staff competence and may be used in further investigations of competence in older people nursing.

Competence in advanced older people nursing: development of 'nursing older people--competence evaluation tool'.

BACKGROUND: Community care is characterised by a move from institutionalised to home-based care, a large patient population with comorbidities including cognitive failure, and nurses who struggle to keep up with their many competence demands. No study has examined the competence of nurses based on present demands, and an instrument for this purpose is lacking. AIM AND OBJECTIVE: We conducted a Delphi study based in Norway to develop the substantial content of a new competence measurement instrument. We sought to reach consensus regarding which nursing staff competence is most relevant to meet the current needs of older patients. DESIGN AND METHOD: A total of 42 experts participated in three consecutive panel investigations. Snowball sampling was used. The experts were clinicians, leaders, teachers, researchers and relatives of older people who required nursing. In Round 1, all experts were interviewed individually. These data were analysed using meaning coding and categorisation. In Rounds 2 and 3, the data were collected using electronic questionnaires and analysed quantitatively with SPSS. RESULTS: The experts agreed that health promotion as well as disease prevention, treatment, palliative care, ethics and regulation, assessment and taking action, covering basic needs, communication and documentation, responsibility and activeness, cooperation, and attitudes towards older people were the most relevant categories of competence. CONCLUSIONS: The experts showed clear consensus regarding the most relevant and current competence for nurses of older people. Assuming that older people in need of health care have the same requirements across cultures, this study's findings could be used as a basis for international studies. IMPLICATIONS FOR PRACTICE: Those who nurse older people require competence that is complex and comprehensive. One way to evaluate nursing competence is through evaluation tools such as the Nursing Older People--Competence Evaluation tool.