Catalysts for change: A qualitative study of middle managers' perception of nursing professional competence in primary healthcare.

AIM: This study aims to explore middle managers' perception of nursing professional competence within the Norwegian primary healthcare service, a sector vital for managing complex patient needs. DESIGN/METHODS: Semi-structured interviews were conducted with four middle managers across different municipalities in Norway. Qualitative content analyses, following Graneheim and Lundman, were used for analysing the transcription of the interviews and the data collected. FINDINGS: The qualitative content analysis revealed three main themes: the significance of advanced competence, challenges related to competence development and the necessity for defining advanced competence. The findings indicate that middle managers recognise the importance of advanced nursing competence in providing comprehensive patient care, notwithstanding challenges in manpower and competence enhancement. CONCLUSION: This research underlines the significance of investing in increased competence and improved management in primary healthcare and offers valuable insights for healthcare policy and practice to enhance patient care.

Capacity for Competence Development: Unlocking Potential for Lifelong Learning in Later Working Life.

The retention of older workers has become a key policy issue in European welfare states. Consequently, there is an increased focus on how lifelong learning, or continued competence development, can extend working life. This article explores the dynamics of competence development among employees aged 55 years and older regarding their learning practices and attitudes toward competence development, based on qualitative fieldwork conducted in nine governmental workplaces across Denmark. To gain a comprehensive understanding of the factors that influence willingness to participate in competence development, the article introduces the analytical framework "capacity for competence development" and highlights five factors that influence this capacity: time, economy, learning culture, energy, and purpose. The article argues that (non)participation in competence development is not static and is not solely the responsibility of employees or managers. Rather, it is co-produced by complex workplace dynamics, including policies, age stereotypes, as well as ways of organizing work and learning. In conclusion, the article emphasizes the potential for competence development and suggests that most employees aged 55 years and older want to participate but await the right circumstances. Their participation could be enhanced through an increased focus on the five identified factors in the capacity for competence development.

Implementing A person-centred CommunicaTION (ACTION) educational intervention for in-home nursing assistants - a study protocol.

BACKGROUND: In this study, the focus is on how to support the competence development needed for nursing assistants in home care. Home care services for older persons can be challenging concerning the nature of the interpersonal interaction and communication needed to care for and respond to the diverse needs of older people who seek to live well in our communities. This implies a need to offer more person-centred care (PCC) to older persons. However, there is a lack of knowledge on how to develop such competence. We, therefore, developed A Person-centred CommunicaTION (ACTION) programme, which is a web-based educational intervention aimed at supporting competence development for nursing assistants. The research objective is to evaluate the ACTION programme with respect to participants' responses to and the effect of the intervention. METHODS: A multicentre case-control study with pre- and post-assessments was designed. The ACTION programme will be implemented at home care units, in two different geographic areas in Sweden. A total of 300 nursing assistants will be recruited: 150 for the intervention group and 150 for the control group. We will evaluate the impact measures and the process. Pre- and post-assessments will be performed with data collected via a) audio recordings of communication, b) a questionnaire on self-efficacy communication skills, PCC, empathy and job satisfaction, c) user data, evaluation forms, field notes and observations, and d) interviews. The data will be analysed with descriptive and analytic statistics and/or qualitative methods for meanings. DISCUSSION: This study has the potential to contribute to the evidence supporting competence development required to offer person-centred and quality home care to older persons and to meet upcoming needs for flexible and easily accessible competence development. TRIAL REGISTRATION: ISRCTN64890826. Registered 10 January 2022, https://www.isrctn.com/ISRCTN64890826.

Multidimensional factors determine skill acquisition development in Guided Self-Determination: A qualitative study.

AIM: The aim of the study was to investigate nurses' skill acquisition in Guided Self-Determination according to the Dreyfus model of skill acquisition and Patricia Benner's studies based on the same model. BACKGROUND: Globally, person-centred care is acknowledged as an essential aspect of quality in health care. To succeed with person-centred care methods and skills are necessary. Guided Self-Determination is a person-centred method developed in the field of nursing. The method represents a new way of skill acquisition requiring knowledge of how skills are acquired, unfolded and best supported in Guided Self-Determination. DESIGN: Qualitative interview study. METHOD: From January 2019 to August 2019, 16 nurses were interviewed about their experiences of learning and using Guided Self-Determination in three different gynaecological settings: cancer, endometriosis and sexual abuse. The study was registered with the Danish Data Protection Agency (file no.: VD-2018-445, I-Suite no.: 6700). RESULTS: The spectrum in Guided Self-Determination acquisition skills ranged from following schematical procedures in a rigorous way to an extended understanding of exploring and supporting the person-centred concept. Two main themes were identified: Elements in the transition of knowledge from theory to practice and Aspects associated with Guided Self-Determination skill acquisition. CONCLUSIONS: Nurses practised Guided Self-Determination at different levels. Quantity of practising Guided Self-Determination was not the only aspect determining rapid progression. The Dreyfus model lacked several explanatory components of skill acquisition, such as personal dispositions, preferences, motivation, personal values and context.

[On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany]. / Zum Stand der Aus- undWeiterbildung in Säuglings-/Kleinkind-Eltern-Psychotherapie in Deutschland.

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

[Journal clubs in nursing practice: An online survey of German university hospitals]. / Journal Clubs in der Pflegepraxis.

Journal clubs in nursing practice: An online survey of German university hospitals Abstract. Background: Journal clubs (JCs) are an evidence-based method for enabling nursing professionals to develop a scientifically based practice. Research results can be made available to nurses to directly influence their nursing practice. The level of implementation in German university hospitals is currently unknown. Aim: This study surveyed the current state of JCs at German university hospitals. The aim is to develop recommendations for the implementation of JCs for nursing practice. Methods: The online survey of all 27 representatives of the "Network of Nursing Science and Practice Development" of the VPU e.V. was conducted from October to November 2020. The questionnaire was developed based on literature. The data analysis was descriptive. Results: 15 of the 19 clinics surveyed currently implement, or have previously implemented, a JC (response rate 70,4%). In approximately half of the clinics, JC is an established structure that is also offered as part of advanced training and continuing education (46,6%) and is used to develop and expand methodological, scientific competencies (86,6%). Positive experiences, but also structural problems in the implementation of a JC were reported. Approximately one quarter of the clinics evaluate their JC regularly (26,7%). Conclusions: JCs at German university hospitals are currently being established. In order to establish JCs on a permanent basis, EBN knowledge must be continuously imparted in further education and training; in addition, JCs should be an essential component of academic role profiles.

Engineering Students as Co-creators in an Ethics of Technology Course.

Research on the effectiveness of case studies in teaching engineering ethics in higher education is underdeveloped. To add to our knowledge, we have systematically compared the outcomes of two case approaches to an undergraduate course on the ethics of technology: a detached approach using real-life cases and a challenge-based learning (CBL) approach with students and stakeholders acting as co-creators (CC). We first developed a practical typology of case-study approaches and subsequently tested an evaluation method to assess the students' learning experiences (basic needs and motivation) and outcomes (competence development) and staff interpretations and operationalizations, seeking to answer three questions: (1) Do students in the CBL approach report higher basic needs, motivation and competence development compared to their peers in the detached approach? (2) What is the relationship between student-perceived co-creation and their basic needs, motivation and competence development? And (3) what are the implications of CBL/CC for engineering-ethics teaching and learning? Our mixed methods analysis favored CBL as it best supported teaching and research goals while satisfying the students' basic needs and promoting intrinsic motivation and communication competences. Competence progress in other areas did not differ between approaches, and motivation in terms of identified regulation was lower for CBL, with staff perceiving a higher workload. We propose that our case typology model is useful and that as a method to engage students as co-creators, CBL certainly merits further development and evaluation, as does our effectiveness analysis for engineering ethics instruction in general and for case-study approaches in particular.

[Health of Indigenous People and Cultural Sovereignty: Developing the Competence of Culture Safety Instructors Under the Long-Term Care 2.0 Program].

Taiwan`s various ethnic groups, including 16 indigenous groups, represent disparate distinct cultures and backgrounds. In long-term care, culturally safe services that reflect cultural expectations and practices must be provided to older-adult recipients of care. As frontline healthcare workers face practical challenges in providing these services appropriately, "cultural safety instructors" may be used to help facilitate indigenous cultural care. Therefore, it is vital to develop the role function and cultural competence of these instructors. In this article, related instructor qualifications, course contents, and expected results of an indigenous cultural safety instruction program are presented based on the theory of cultural competence and cultural safety. In addition, relevant perspectives on cultural safety instructors and their cross-cultural competence specific to indigenous peoples, including Dimitrov and Haque (2016) and Leininiger (1996), are integrated. It is hoped that this study promotes reflection and provides a reference on practice and policies related to long-term care for indigenous people.

Organizational determinants of bullying and work disengagement among hospital nurses.

AIMS: To identify organizational determinants of bullying and resulting work disengagement among hospital nurses. DESIGN: A cross-sectional, web-based, anonymous questionnaire study. METHODS: The questionnaire was administered in 2017 to all Registered Nurses in a regional healthcare system in the United States (N = 1,780), with 331 complete responses. Logistic regression was used to identify factors associated with personally experiencing and witnessing bullying, respectively. Linear regression was conducted to identify organizational factors associated with disengagement due to bullying. RESULTS: Psychological safety, a measure of team trust and respect, was inversely associated with being personally bullied and witnessing bullying. Being personally bullied, but not witnessing bullying, was associated with disengagement due to bullying. Psychological safety and competence development, a measure of opportunities to develop skills and knowledge at work, were both inversely associated with disengagement due to bullying. CONCLUSION: Hospital units characterized by trust and respect among nurses are less likely to have a culture of bullying. Both psychological safety and competence development have a protective effect on nurse disengagement from the workplace due to bullying. Interventions to mitigate and prevent bullying and work disengagement among nurses should encompass efforts to enhance psychological safety and opportunities for competence development. IMPACT: Bullying is a pervasive hazard in the nursing profession that contributes to unhealthy workplaces. Nurse managers and staff nurses should work together to establish psychologically safe environments where nurses dare to discuss tough issues like bullying. This research contributes to understanding the characteristics of work environments in which nurses can thrive and work effectively.

[Psychotherapy training in Austria: Baseline and socio-demographic background data from a SPRISTAD (Society of Psychotherapy Research Interest Section on Therapist Training and Development)-Pilotstudy]. / Psychotherapie-Berufsausbildung in Österreich: Basis- und soziodemographische Hintergrunddaten aus einer SPRISTAD-Pilotstudie (Society of Psychotherapy Research Interest Section on Therapist Training and Development).

Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.

Modeling competence development in the presence of selection bias.

A major challenge for representative longitudinal studies is panel attrition, because some respondents refuse to continue participating across all measurement waves. Depending on the nature of this selection process, statistical inferences based on the observed sample can be biased. Therefore, statistical analyses need to consider a missing-data mechanism. Because each missing-data model hinges on frequently untestable assumptions, sensitivity analyses are indispensable to gauging the robustness of statistical inferences. This article highlights contemporary approaches for applied researchers to acknowledge missing data in longitudinal, multilevel modeling and shows how sensitivity analyses can guide their interpretation. Using a representative sample of N = 13,417 German students, the development of mathematical competence across three years was examined by contrasting seven missing-data models, including listwise deletion, full-information maximum likelihood estimation, inverse probability weighting, multiple imputation, selection models, and pattern mixture models. These analyses identified strong selection effects related to various individual and context factors. Comparative analyses revealed that inverse probability weighting performed rather poorly in growth curve modeling. Moreover, school-specific effects should be acknowledged in missing-data models for educational data. Finally, we demonstrated how sensitivity analyses can be used to gauge the robustness of the identified effects.

Nurses' competencies in home healthcare: an interview study.

BACKGROUND: Nurses working in Home healthcare (HHC) are facing major challenges since more advanced care and treatment are increasingly being carried out in patients' homes. The aim of this study has been to explore how nurses experience their competencies in HHC situations. METHODS: This study has a qualitative and explorative design. Ten nurses were interviewed and data was analyzed using content analysis. RESULTS: The themes "Being a capable nurse", "Being a useful nurse" and "Being a subordinate and dependent nurse" were identified. Nurses want to be capable of taking care of patients, to develop their competencies and to perform their duties in the way required. They also want their work to be useful and to provide good and safe HHC. Finally, nurses want to improve HHC care by applying their competencies. Simultaneously, they are subordinate and dependent in relation to their manager and also dependent upon their manager's interest in encouraging nurses' competence development. CONCLUSIONS: Nurses in HHC are responsible for many seriously ill patients and they want to contribute to good and safe patient care. To maintain patient safety, reduce the risk for burnout and staff turnover as well as to contribute to a sustainable development of the work, strategies for transferring competencies between nurses and efforts for competence development are needed.

[Supporting Early Childhood Teacher's Competences in the Encounter with Refugee Children and their Families]. / Die Unterstützung der Kompetenzentwicklung von Kita-Teams in der Begegnung mit Kindern und Familien mit Fluchterfahrung.

Supporting Early Childhood Teacher's Competences in the Encounter with Refugee Children and their Families Children and families with experiences as refugees bring out a challenge for the professionals in early childhood institutions (kindergarten). A curriculum to strengthen the competencies of early childhood teacher teams in the encounter with children and families with flight experiences was developed, implemented and evaluated. The article shows the objectives of this curriculum and the first evaluation results. The evaluation with qualitative and quantitative methods shows an increase of self-assessed security and competences in the pedagogical contact/encounter with the target group. A relevant success factor was the adaptation of the frame curriculum to the needs and situation of the specific early childhood teacher teams.

The experiences and perceptions of nurse educators of culturally and linguistically diverse nursing students' competence development - Qualitative study.

BACKGROUND: Many countries are becoming increasingly culturally and linguistically diverse due to globalisation and migration. The global shortage of nurses and the consequent migration of nursing professionals is leading to increasing cultural and linguistic diversity in health care and nursing education. Nurse educators play a significant role in supporting nursing students' competence and working life readiness. RESEARCH AIM: To describe nurse educators' experiences and perceptions regarding competence and competence development of CALD nursing students. METHODS: The study was conducted using a descriptive qualitative approach utilising individual thematic interviews for data collection. A purposive sample consisting of 20 volunteer nurse educators from five higher education institutions was used for the purpose. Data was collected in semi-structured interviews based on a literature review of previous studies. The data were analysed using inductive content analysis. The COnsolidated criteria for REporting Qualitative research (COREQ) criteria were used in the reporting of this study. RESULTS: According to the content analysis, three main categories describing aspects related to the competence and competence development of CALD nursing students were identified: 1) educator's competence to support student's learning process and competence development, 2) development of supportive structures and safe learning environments, and 3) student-specific competence and competence development. The educators emphasised that setting clear goals, providing encouragement, having an open discussion, and student-centered approach to support their learning process and create a safe learning environment. CONCLUSIONS: Supporting the learning process of CALD nursing students and developing safe learning environments were considered essential for the development of competence. These areas must be supported by developing educators' pedagogical and cultural competence and providing sufficient resources for both students and educators. In addition, the curriculum must be designed to support these aspects.

Older workers and extended working life - Managers' experiences and age management.

BACKGROUND: In 2020 the Swedish Government started a gradual raising of the retirement age, but employers have been silent on the issue. Little is known about whether and how they reflect on what it will mean for their organization, or whether they already have, or are going to, make arrangements in order to facilitate and motivate older workers to stay longer. OBJECTIVE: The aim of this study was to explore and describe managers' experiences of older workers and age management in connection with the increase of the retirement age in Sweden. METHODS: Data was collected through semi-structured interviews with fourteen managers from a broad set of organizations in the public and private sectors, and from the Middle and East of Sweden. The transcribed material was analysed in line with qualitative content analysis. RESULTS: The analysis ended up in seven main categories with associated sub-categories: Older Workers, Retirement Ages, Transition Initiatives, Competence Transfer, Competence Development, Increased Retirement Ages, Knowledge Gaps. CONCLUSION: Our findings reveal that there is an ambivalence in addressing the issue of age among the interviewed managers, what we have interpreted and labelled as "silent age discrimination", and it was shown that they do not have elaborated strategies for age management.

Practice of Vietnamese tertiary learners' intercultural competence: An influential factor affecting entrepreneurial capabilities.

Intercultural competence (IC) is believed to enhance new graduates' entrepreneurial capabilities and employability in this 21st century. This quantitative study investigates learners' perceived levels of IC, regarding its four components: knowledge, attitudes, skills, and awareness [1,2]. An online survey comprising 40 items adapted from Baroudi's questionnaire [3] based on Byram's conceptual framework of IC [1,2] was administered to learners at a recently established state university in the Mekong Delta of Vietnam. 148 eligible respondents were recruited on a volunteer basis. SPSS was used to analyze collected data. Results show learners' high perceived level of IC. Learners' intercultural attitudes component was found to be at the highest perceived level. In addition, knowledge and skills equally stood at the lowest level of learners' perceived IC. Learners' gender and academic field did not affect their perceived IC levels. However, participants' academic major showed to have a significant impact on learners' intercultural awareness. The findings inform stakeholders about the appropriateness of currently-implemented curricula for intercultural education and raise their awareness of the possible gap between learners' perceived levels of IC and their actual IC. The study also contributes insights into the literature on the relationship between learners' IC and entrepreneurial capabilities and employability. Finally, suggestions for future studies on IC are included.

Effects of Arts-Based Pedagogy on Competence Development in Nursing: A Critical Systematic Review.

The integration of arts-based methods into nursing education is a topic of growing interest in nursing practice. While there is an emerging body of research on this subject, evidence on competence development remains vague, largely due to methodological weaknesses. The purpose of this review is to evaluate the effectiveness of arts-based pedagogy in nursing, specifically in terms of students' changes in knowledge, skills, and attitudes. It explores which arts-based approaches to nursing education qualify as evidence-based practice in terms of nursing competence. A systematic critical review of research on arts-based pedagogy in nursing was conducted, identifying 43 relevant studies. These studies were assessed for methodological quality based on the CEC Standards for evidence-based practice, and 13 high-quality comparative studies representing a variety of arts-based approaches were selected. Creative drama was identified as the only evidence-based practice in the field, positively affecting empathy. The findings highlight a research gap in nursing education and emphasize the need for measurement and appraisal tools suitable for the peculiarities of arts-based pedagogy.

Outcomes of Art-Based Leadership Development: A Qualitative Metasummary.

Art-based leadership development, grounded in experiential learning, offers a learner-centered approach to leadership training by integrating relational, aesthetic and embodied dimensions. This systematic review investigates evidence on the outcomes of art-based leadership development, addressing the critical need for empirical validation of its effectiveness. A qualitative metasummary was employed to review 31 empirical studies published between 2008 and 2023. The studies were sourced from databases including Business Source Complete, ERIC, PsycINFO, Scopus, and Web of Science. The Quality Assessment for Diverse Studies (QuADS) tool was used to assess the studies. The analysis revealed that art-based methods significantly enhance reflective and reflexive practices, higher-order cognitive skills, emotional intelligence, and interpersonal competencies. Representing leader development, art-based initiatives facilitate holistic self-discovery and transformative shifts in mindset, offering a valuable complement to conventional skill-based approaches. Despite these promising benefits, the review highlights a need for more rigorous empirical studies, particularly longitudinal and quantitative research, to substantiate the long-term effectiveness of art-based methods.

Activation of the general stress response sigma factor SigB prevents competence development in Bacillus subtilis.

Seemingly simple bacteria mount intricate adaptive responses when exposed to physical stress or nutrient limitation, and the activation of these responses is governed by complex signal transduction networks. Upon entry into the stationary growth phase, the soil bacterium Bacillus subtilis may develop natural competence, form biofilms or stress-resistant cells, or ultimately trigger a cellular differentiation program leading to spore formation. Master regulators, such as Spo0A, ComK, SinR, and SigB, constantly monitor the bacterium's environment and then determine appropriate adaptive responses. Here, we show that exposure of B. subtilis to visible light and other stresses triggers a general stress response-dependent block in competence development. SigB serves as an "emergency system" to silence inappropriate expression of an alternative developmental program in the face of unfavorable conditions. In particular, we document a stress-dependent molecular mechanism that prevents accumulation of the central competence regulator ComK via expression of a SigB-driven antisense RNA (as-comK, S365) which is part of a noncontiguous operon. IMPORTANCE: Bacillus subtilis exhibits a large number of different specific and general adaptation reactions, which need to be well balanced to sustain survival under largely unfavorable conditions. Under specific conditions, natural competence develops, which enables B. subtilis to actively take up exogenous DNA to integrate it into its own genome. In contrast to this specific adaptation, the general stress response is induced by a variety of exogenous stress and starvation stimuli, providing comprehensive protection and enabling survival of vegetative B. subtilis cells. In the present work, we reveal the molecular basis for the interconnection of these two important responses in the regulatory network. We describe that the master regulator of the general stress response SigB is activated by physiological stress stimuli, including daylight and ethanol stress, leading to the inactivation of the competence master regulator ComK by transcriptional anti-sense regulation, showing a strict hierarchy of adaptational responses under severe stress.

Scaffolding in Health Sciences Education Programmes: An Integrative Review.

The complexity of health sciences programmes justifies scaffolding to support students in becoming competent health professionals. This article reports on an integrative review that aimed to describe the application of scaffolding in health sciences programmes. Twenty-nine sources, inclusive of theoretical and empirical studies, were reviewed. The sequencing of educational activities, the application of scaffolding tools or resources, frameworks for applying scaffolding, modelling, and fading represented the application of scaffolding in health sciences programmes. Awareness of the application of scaffolding in health sciences programmes could contribute to enhancing competence development among students when applied across all learning platforms.