Validation of time to task performance assessment method in simulation: A comparative design study

<p><strong><em>Background</em></strong><strong><em>:</em></strong><em> Nursing care provided to patients, especially in hospitals, is expected to be of high quality, and its implementation is in accordance with the nurse's clinical competence. </em></p><p><em><strong>Objectives:</strong> This scoping review aimed to assess the implementation of the clinical competence of nurses in hospitals so that a clear picture of the implementation of these competencies is obtained. In addition, this study can be evidence-based and related to implementing these clinical competencies. </em></p><p><strong><em>Methods:</em></strong><em> </em><em>This literature review used PICO framework to develop articles questions (P: nurses, I: not applicable, C: not applicable, and O: application of clinical nursing competency). Articles search for literature review was conducted during April and May 2023. </em><em></em></p><p><em>This study used Pubmed and ScienceDirect Databases and other sources. The keywords that used in this scoping review was </em><em>“nursing competency” OR “clinical nursing competency” AND “evaluation” OR “implementation” AND “hospital”.</em><em></em></p><p><strong><em>Results: </em></strong><em>There were 1,150 articles from the search results, but only seven were included for review. One article is a descriptive comparative study using a qualitative approach, and six articles are cross-sectional studies. The articles are publications within five years (2019-2023). In its implementation, the average clinical competency of nurses is at a low to moderate level, and only one study found was at high nurse competency. The results of the supervisor's clinical competency assessment were significantly lower than those assessed by oneself and the group. In addition, </em><em>the nurse competency level was moderate, and there was no significant difference in the clinical competency of nurses before and during the COVID-19 pandemic.</em><em></em></p><strong><em>Conclusions: </em></strong><em>The implementation of nurses' clinical competence has yet to be optimal, so hospital management needs to improve nurses' clinical competence so that nurses can provide higher quality and professional nursing care in the hospital.</em>

Background: ‘Competency’ is an important word in health care settings. From a novice nurse to a proficient registered nurse whoever is assessing a newly admitted patient or feeding a patient in a unit or a student nurse in a nursing education program continuous clinical competence is essential for everyone. The definition of clinical competence clearly refers to individual competence. It is thought to involve many aspects of the nurses’ professional attributes, including the individual’s personality trait, level of education, experience in practice and health care management skill. ICU nurses are expected to have superior professional knowledge and skills, be familiar with modern technical equipment and dedicated to the patient. Requirements for working in ICUs differ from one country to another. Nurses previously registered just once, after graduation, but are now required to demonstrate continuing competence if they are to maintain their registration. At the same time, communities expect safe and competent health care as a right. To fulfil their expectation, nurses need to be professionally and clinically competent.Materials and Methods: The present research study was conducted on 218 registered nurses selected by simple random sampling. The purpose of the study was explained to the nurses and written consent was taken from them and also assurance was given to maintain the confidentiality. The baseline data was collected from the samples using the structured interview schedule. Level of nurses clinical competencies was assessed by using the observational checklist and the factors influencing the clinical competencies of the ICU nurses was assessed by the Nurses competence scale (Rating Scale).Results: As per the score of observation checklist and three longitudinal observations to assess the level of clinical competencies of ICU nurses, the maximum score of clinical competencies of ICU nurses are within the range of very good (38-48) with majority of nurses (84.86% in 1st observation, 74.31% in second observation and 68.34% in third observation respectively %) with an average mean± SD of 44.87± 3.04, 44.36± 2.86 & 45.16± 2.876 respectively. There is no significant difference among the average of three observations made while assessing the level of clinical competencies of ICU nurses.The factors especially teaching –coaching (37.66±10.06; Range: 10-68), diagnostic functions (16.6 ± 4.56; Range 3-37) and work role (45.4±12.48; Range: 0-58) has maximum score suggesting that these three factors had influence on the clinical competencies of ICU nurses. The factors especially teaching-coaching, diagnostic functions and work role are significantly influencing the level of the clinical competencies of ICU nurses.There is significant association between the levels of clinical competencies of ICU nurses such as knowledge, experiences, environment, independence and work satisfaction with only four selected demographic variable i.e. age, usual length of shift duty the nurses work, average patient assignment and years of experience in the hospital. The factor such as teaching-coaching is significantly associated with average patient assignment. Diagnostic functions’ is associated with salary per month (in Rs.) of ICU nurses and work role is significantly associated with years of experience of ICU nurses.Conclusion: The study concludes that the factors such as teaching-coaching, diagnostic functions & work role have maximum influences on the level of clinical competencies of ICU nurses.

Objective measures of performance are seldom perfect. In response, incentive contracts often include important subjective components that mitigate incentive distortions caused by imperfect objective measures. This paper explores the combined use of subjective and objective performance measures in (respectively) implicit and explicit incentive contracts. Naturally, objective and subjective measures often are substitutes, sometimes strikingly so: we show that if objective measures are sufficiently close to perfect then no implicit contracts are feasible (because the firm's fallback position after reneging on an implicit contact is too attractive). We also show, however, that objective and subjective measures can reinforce each other: if objective measures become more accurate then in some circumstances the optimal contract puts more weight on subjective measures (because the improved objective measures increase the value of the ongoing relationship, and so reduce the firm's incentive to renege). We also analyze the use of subjective weights on objective performance measures, and provide case-study evidence consistent with our analyses.

Subjective versus objective measures of distress, arousal and symptom burden in patients with functional seizures and other functional neurological symptom disorder presentations: A systematic review

BACKGROUND:Nurses play a crucial role in patient-care. Therefore, assessing nurses’ clinical competence is essential to achieve qualified and safe care. The aim of this study was to determine and compare the competence assessments made by head nurses and practicing nurses in a university hospital in Iran in 2009.METHODS:A cross-sectional survey was conducted to make comparisons of both self-assessment of nurse competence as well as assessment made by their respective head nurses working in a university hospital setting in Iran. The instrument employed for data collection was Nurse Competence Scale (NCS), whose reliability and validity have been previously confirmed. The clinical competence of the nurses in 73 skills under 7 categories was determined based on a Visual Analogue Scale (VAS) (0 to 100). They were also asked to indicate the extent to which their competence was actually used in clinical practice on a four-point scale of Likert. The data was analyzed through descriptive and inferential statistics.RESULTS:Comparison of self-assessment (87.03 ± 10.03) and the assessment done by head nurses (80.15 ± 15.54) showed a significant difference but no precise differences were found between the assessment methods for the frequency of using these competencies.CONCLUSIONS:The results of this study indicated no consensus between the nurses owns assessment and their head nurse assessment. Therefore, it is necessary to use a combination of nurses’ competence assessment methods in order to reach a more valid and precise conclusion.

Objective: This case study describes the introduction and evaluation of a structured perioperative education program for novice nurses in the theatre setting to address ongoing retention and attrition rates of skilled perioperative nurses. Background: A proficient and dynamic workforce is essential for speciality areas, including surgical theatre environments. Whilst perioperative nurse education occurs at undergraduate and postgraduate universities, assimilation and further development of skills into the work environment takes time and requires a supportive workplace culture. Lack of support and exposure to clinical experience limits the competency and confidence of novice nurses, which negatively affects retention in specialty areas. Study Design: Twenty novice nurses underwent a three-month rotation across 14 perioperative speciality areas with an assigned nurse mentor between 2021 and 2024. An educational learning package was developed to track the knowledge, confidence, and capability of novice nurses. Focus group sessions were held every three months, and surveys were administered to assess the overall effectiveness of the program. Results: Nineteen novice nurses reported increased confidence in their knowledge and overall confidence in the clinical area. Findings demonstrated that the program’s structure was a strength, while organisational impacts were the main barrier, including a lack of staff and time pressures identified as barriers. Overall, workplace culture was improved for all staff with improvements in staff retention. Conclusion: The retention of skilled perioperative staff is essential for best patient outcomes, organisational efficiencies, and a positive work culture and environment. This project has been successful in bridging the theory-practice gap, promoting skill acquisition and professional confidence for NN, whilst enhancing positive workplace culture and staff retention within the study setting. There is a need to review the self-paced learning booklets to enhance the documentation and to show completion by all participants. Implications for practice: Attrition rates in speciality areas that require a high level of ability, such as the perioperative environment, remain a constant concern for healthcare. This study proves the importance of investing in skill development for novice perioperative nurses through a structured educational program in the clinical setting. Supportive frameworks enhance nurses’ knowledge and confidence, leading to retention in speciality areas.

Novice and Expert Nurses’ Eye Movements and Success With Simulated Peripheral Intravenous Catheterization

Objective vs Subjective Measurements of Palatine Tonsil Size in Patients with OSA

BackgroundThe physical and mental demands of handball during training or competition often lead to fatigue which can impair performance. Many attempts have been made to assess the level of fatigue in athletes either by objective (neuromuscular performance) or subjective (questionnaires) measures, however, their interplay over short-, mid-, and long-term periods is currently unknown. Knowledge about both types of assessments is important as load management by coaches is traditionally based on direct adjustments following a training session, adjustments of content structure of training weeks between games, as well as adjustments of load management over the entire competitive season. Thus, this study aimed to investigate the interplay between objective and subjective fatigue measures at multiple test times throughout a handball season.MethodsA total of 100 highly trained (Tier level 3) adolescent or young adult team handball players (23 females) took part in the study. The parameters tested were the Leg Recovery Test (LRT score) which is based on the countermovement jump height (CMJ) and was assessed by a commercial wristwatch (Polar Vantage V2) as an objective measure of neuromuscular fatigue. Additionally, on a subjective level, questionnaire-based athlete self-report measures, specifically the Perceived Recovery Status Scale (PRSS) and the Short Scale of Recovery and Strain (KEB) were assessed. We used non-parametric tests to detect differences between relevant test time points (short-term: immediately following one handball-specific training session, i.e., from T0 to T1; mid-term: over the course of three consecutive training days, i.e., from T0 to T2; long-term: over the course of 8 months of training, i.e., from T0 to T12) and linear mixed models to evaluate the interplay between objective (LRT score) and subjective (KEB score and PRSS score) measures of fatigue across one season.ResultsNon-parametric tests showed that CMJ height (p = .012) and the KEB (p < .001) were higher at T1 compared to T0 for the short-term assessment. Over the course of three consecutive training days (i.e., mid-term assessment), the CMJ height score decreased (T0 to T2: p < .001; T1 to T2: p = .018) and the PRSS score (T0 to T2: p < .001; T1 to T2: p = .003) increased. Linear mixed models revealed no significant effects of KEB or PRSS score on LRT score (i.e., CMJ height) for the short- and mid-term assessments. In terms of the long-term assessments, we detected no general direct or interaction effects of PRSS score, workload, and test time point on LRT score, except for an interaction between PRSS score and workload on LRT score (p = .032), which indicates a workload-dependent association between PRSS and the objective fatigue measure (LRT score).ConclusionAthlete self-reported measures of fatigue indicated significantly higher cumulative fatigue after both short- and mid-term periods, whereas this increase was observed in the LRT score only during the mid-term period. Furthermore, the absence of a relationship between the objective and subjective measures of fatigue during short- and mid-term periods suggests that these measures assess distinct types of fatigue. In the long-term assessments, the significant interaction between the PRSS score and workload on the LRT score suggests that higher workloads are associated with an increased correlation between subjective (PRSS score) and objective (LRT score) measures of fatigue. This indicates that perceived fatigue may be a more sensitive indicator of fatigue, which can be managed to maintain high levels of neuromuscular performance (LRT score). However, with higher workloads (>10 h per week), associations between the objective and subjective measures become apparent, suggesting that workload serves as a common factor influencing overall fatigue.

Subjective and objective measures available at the time of medical school admission were related to subjective and objective clinical performance measures during medical school. Strategies were developed for coding narrative faculty comments from admissions interviews and clinical performance evaluations. Factor analysis was used to examine underlying structures for both admission and clinical performance measures. Summed scores were calculated to represent each factor, and multiple regression was used in predicting each of the clinical factors from the admission factors. Multiple regression showed that admission interview comments best predict narrative clerkship performance, while objective scores best predict an objective measure of clinical knowledge. Conclusions were: (a) narrative information can be coded reliably. (b) Objective and subjective measures are distinct, identifiable structures both at admission and during the third year of medical school. (c) Prediction formulas will vary depending on what outcome variables are chosen.

This study investigated the clinical utility of the combined use of objective and subjective measures of attention-deficit/hyperactivity disorder (ADHD) prepharmacological and postpharmacological treatment. Adults with ADHD (N = 77) completed the Quantified Behavioral Test, self-ratings of ADHD-related symptoms, and quality of life measures pretreatment and posttreatment. The use of objective and subjective measures of ADHD-related symptoms during initiation and follow-up of pharmacological treatment resulted in significant improvements in quality of life after 6 months. Both objective and subjective measures captured changes in ADHD-related symptoms, with more patients showing clinically relevant treatment effects on objective measures. Convergence rates between objective and subjective measures were low to moderate, and improvements on these measures correlated with increased quality of life. Objective and subjective measures of ADHD capture important components of the condition. The findings from this study have important implications for clinical practice.

Few objective measures of evidence-based practice (EBP) knowledge/skill exist. The Fresno Test, one objective method, was validated first with medicine, followed by versions for physical therapists, occupational therapists, speech therapists, social workers, dietitians, pediatric nurses, and health care students. The Fresno Test was adapted and tested with cohorts of acute care nurses. Six of the 14 items required revision to achieve acceptable psychometrics. The aim of this second validation study was to revise and validate a new version of the test, The Modified Fresno Test-Acute Care Nursing (MFT-ACN), to determine if it could distinguish EBP knowledge/skills among acute care nurses. A panel of eight EBP experts were engaged in multiple Delphi rounds to revise items. Individual-content validity indices (CVI) ranged from 0.83 to 1.0, with scale-CVI 0.92. Using a cohort design, a cross-sectional sample of 90 novice, master, and expert nurses were recruited via national listservs or snowball sampling to complete the revised test. Two doctorally prepared EBP experts independently scored tests using the standardized rubric. The MFT-ACN yielded strong psychometric properties (intra-class correlation coefficients > 0.80; item discrimination indices > 0.20; item-total correlations > 0.30). One poorly performing item was dropped per a priori cut-off values. The final test included 13 items, with a Cronbach's alpha=0.77. Item difficulty was moderate to high. Most items discriminated well between cohorts. Mean total scores were positively correlated with age, years since graduation, years of acute care experience, and formal EBP or research workshops or conferences or courses or immersions. Perceived level of EBP expertise was not associated with mean scores. Further research is recommended with a larger sample to assess the tests' responsiveness to change in EBP knowledge/skills over time and enhance its acceptability and feasibility. Additional research should further evaluate construct and concurrent validity against other objective assessments of EBP knowledge/skills. The validated 13-item MFT-ACN can be used to evaluate EBP competencies of acute care nurses in academic and practice settings. It can also be used by nurse scientists to build a stronger evidence base on types of educational programs that excel in advancing the critical competency of EBP among our nursing workforce.

Objectives: This study aimed to assess perceived clinical competence levels of emergency department nurses in Iran and to identify association with the demographic variables. Methods: In this cross-sectional study, all 131 employed nurses from emergency departments of four educational hospitals were included in the study using a census method. Data collection tools included a demographic information form and the “Nurse Competence Scale”. Data were analyzed using descriptive and analytical statistics. Results: The mean age of the nurses was 32.41± 6.35 years. 14 nurses were male and 117 nurses were female, the average work experience of the nurses was 8.48±5.98 years. The mean score of nurses' clinical competence score of the nurses was 68.68 ± 3.24 out of 100, which was a “good level”. Among the subscales of clinical competence, the highest mean score was related to “managing situation” and lowest to “ensuring quality”. There was no statistically significant difference of clinical competence by gender, age, and academic degree. However, the level of clinical competence differed significantly depending on work experience. Conclusions: The emergency department nurses at Mazandaran University of Medical Sciences, Iran, reported a good level of clinical competence across all categories. Hospital managers’ awareness of the level clinical competence of emergency department nurses helps them design educational programs and effective training session to improve the quality of nursing services. Moreover, it is necessary to upgrade nursing education programs at all levels of nursing education in to improve graduating nurses’ clinical competences.

Revisiting 'Assessment of clinical competence using an objective structured clinical examination (OSCE)'.

BackgroundPrior studies have reported associations between neighborhood characteristics and late‐life cognition. These studies assessed neighborhood using either objective (e.g., area‐level data from public database) or subjective (individual‐level perception) measures. However, little research has been done to examine effects of objective and subjective measures simultaneously. The present study aims to investigate the independent associations of objective and subjective neighborhood characteristics with cognitive change in older adults.MethodParticipants include 316 individuals in the Einstein Aging Study (mean age = 77; 67% females; 45% non‐Hispanic Whites, 40% non‐Hispanic Blacks). Subjective neighborhood measures included perceived neighborhood safety, aesthetic quality, social cohesion, and availability of healthy foods (range = 1 poor to 5 excellent). Objective neighborhood measures included violent crime, neighborhood deprivation, volunteering rates, percentage of healthy food retailers, and low access to healthy food. Processing speed was assessed using the brief, smartphone‐administered Symbol Search Test, and was completed 6x/day over two weeks; this was repeated annually from 2017 to 2022. To account for non‐linear retest/practice effects, double negative exponential models were used to estimate the relation of neighborhood measures to asymptotic performance (i.e., fastest response time) at baseline and to change in asymptotic performance over time.ResultMost subjective and objective neighborhood measures were significantly correlated with each other (Table 1). In models containing both objective and subjective neighborhood measures, better perceived safety was associated with greater annual improvement in asymptotic performance (40 milliseconds/year for one point increase in safety) while the objective measure of violent crime was not. Perceived availability of healthy foods was independently associated with a faster baseline asymptotic processing speed (estimate = 160 milliseconds) and with greater annual improvement rate (estimate = 54 milliseconds/year) while the objective measures of food environment were not (Table 2).ConclusionSubjective rather than objective neighborhood characteristics were strongly associated with annual rates of change in processing speed over five years in community‐dwelling older adults. Perception of one’s neighborhood may be a more proximal predictor of cognitive health as it may reflect an individual’s lived experiences and determine one’s psychological states and health‐related behaviors. Alternatively, more fine‐grained objective neighborhood measures (e.g., individual‐level) would be necessary to better characterize objective neighborhood environments.