Competent Care Research Articles

Evaluation of antenatal care competency with Objective Structure Examination Blended Learning (OSCE-BL)

Evaluation of antenatal care competency with Objective Structure Examination Blended Learning (OSCE-BL)

Teaching Skills for Cultural Competence: Are Midwives Prepared for Practice?

Midwives are becoming increasingly available to women of all cultural and socioeconomic groups. Understanding the impact of socioeconomic and cultural issues on women’s health is critically important in providing comprehensive care to women. If prepared, midwives have an opportunity to provide individualized, culturally sensitive care. A pubmed search on cultural competence in midwifery care revealed much about cultural competence in women’s health and nursing, but little about educating midwives. A subsequent Google scholar search on obstetrical care was helpful in identifying desired skills and behaviours among practitioners as well as how to teach such skills to learners. This paper addresses the skills necessary for providing culturally competent midwifery care and describes how these skills are presently taught in the Ontario Midwifery Education Program. Recommendations for further development and evaluation of culturally competent maternity care are provided.

Mental Illness in Refugee and Immigrant Women: A Midwife's Perspective on Culturally Competent Care

The assessment, diagnosis and referral for mental illness management have been recognized as indispensable roles within midwifery practice both in the United States and in Canada. War, civil unrest and natural disasters, have made mental health assessment crucial for refugee and new immigrant women who present as midwifery clients. Since 1991, National Depression Screening Day (NDSD) had been conducted in cities across the United States and Canada using the Harvard Department of Psychiatry National Depression Screening Day Scale (HANDS©). It facilitates the diagnosis of depression based on DSM-IV criteria. The HANDS© tool includes a 10-item interview guide which is a “self-report scale”. HANDS© demonstrated good internal consistency and validity and was 95 percent sensitive.33 Responses could indicate the need for thyroid screening, referral for mental health counselling or psychiatric care. Strategies for transforming midwifery practice are explored: taking a holistic approach, communication strategies, continuing education strategies, documentation and empowerment issues, multidisciplinary team approach, clinic environment issues, resources and referral base. As we develop expertise in the care of torture and trauma survivors, it behooves us to identify the experts amongst our ranks and to refer our clients to these midwives who will best meet their needs. Further research is needed to guide our incorporation of the skills for treating survivors in our educational programs for the midwives of the future.

Preparedness of Speech Language Pathologists and Occupational Therapists to Treat Pediatric Feeding Disorder: A Cross-Sectional Survey.

Pediatric feeding disorder (PFD) is increasingly common and is often treated by speech language pathologists (SLPs) and occupational therapists (OTs) in the community setting. However, the preparedness of these disciplines to effectively address PFD is relatively unknown. A national (US), online survey was disseminated to providers who assess and treat PFD. For the present analysis, the responses of SLPs (N = 418) and OTs (N = 195) related to their clinical background, educational background, post-graduate training, and self-rated clinical effectiveness were statistically analyzed and compared across the two disciplines. Both SLPs and OTs report feeling underprepared to work with PFD clients immediately following their academic training, but time spent in post-graduate training and years of clinical practice both significantly (p < 0.0001) increased feelings of effectiveness in assessing and treating PFD. Most SLPs and OTs pursued self-directed learning activities to increase competence, with the most common activities being article review, podcasts, and peer case review, although SLPs were significantly more likely to use podcasts (p < 0.0001) and peer review (p = 0.0004) than OTs. The most common barriers for providers were financial, time, travel, and institutional support barriers. While PFD is a key practice area of both SLPs and OTs, both provider groups feel unprepared and under-supported in providing competent care to these patients upon graduation. Future research and policy should support advancements in training for current SLPs and OTs related to PFD and address current barriers to a specialized educational pathway.

Adopting the World Health Organization’s eye care competency framework in Saudi healthcare system

Adopting the World Health Organization’s eye care competency framework in Saudi healthcare system

Core competencies among nurses engaged in pallative care: A scoping review.

To synthesize available evidence about core competencies for nurses engaged in palliative care. A scoping review conducted according to the framework from Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist was adopted to report this scoping review. The PubMed, Web of Science, Embase, ScienceDriect, CNKI, WangFang, VIP and Sinomed databases were used to systematically search for published studies from their inception to December 2023. Two researchers independently screened and selected relevant studies and performed the data charting. Twenty-six studies were included in this scoping review. Among these, 14 studies identified core competency assessment instruments among nurses engaged in palliative care, with the Palliative Care Core Competence Questionnaire was used most frequently; 13 studies investigated the status of core competencies of nurses engaged in palliative care, the majority of included studies indicated that nurse's core competencies were at moderate levels; 11 studies explored the factors influencing the core competencies of the nurses engaged in palliative care, which were classified as sociodemographic-related factors, palliative care education-related factors, death attitude, palliative care practice-related experience and others. This scoping review offers a comprehensive overview of the current landscape of core competencies among nurses in palliative care. Findings suggested that the clinical nursing leaders need to develop tailored strategies and interventions to address specific factors and promote the continuous development of nurses' competencies in palliative care. Core competency assessment instruments equip nurses and healthcare organizations with a range of validated tools for evaluating their proficiency in palliative care. Targeted core competency enhancement programmes need to be developed to foster a nursing workforce better equipped to improve the quality of life of end-of-life patients and their families. No patient or public contribution.

Facilitating Culturally Competent Breast Imaging Care in South Asian Patients.

South Asians are a rapidly growing subset of the Asian population in the United States. They comprise people from multiple countries with diverse beliefs, languages, and cultural identities and values. The incidence of breast cancer is rising in South Asian women in the United States, with earlier onset and predilection for HER2-enriched tumors. Despite the rising incidence of breast cancer, participation in screening remains lower than other populations. Health care inequities in South Asian women are multifactorial and may be due to traditional health beliefs and practices, language barriers, cultural differences, and lack of overall awareness. Developing a culturally sensitive environment in breast imaging clinic practice can lead to improved patient care and adherence. Given the scarcity of data specific to the South Asian population in United States, there is a need for health service researchers and practice leaders to obtain more high-quality data to understand the needs of South Asian patient populations.

Spiritual Care[Givers] Competence in Palliative Care: A Scoping Review.

To deliver spiritual care, professionals must be skilled in physical, mental, social, and spiritual care. Spiritual care competence includes knowledge, behaviors, attitudes, and skills that enable successful or efficient care. This review aims to identify the scope of competence and the specific skills, knowledge, and attitudes used in providing spiritual care to people needing palliative care, and the main challenges and facilitators. A scoping review was developed using the Joanna Briggs Institute methodology. Six databases (Web of Science; MEDLINE/Pubmed; Scopus; CINAHL; MedicLatina and SciELO) were searched in September 2023, with an update in January 2024. The resulting 30 articles were analyzed using a content analysis approach. Information was categorized into three domains: cognitive, affective, and functional (based on three personal resources: intrapersonal, interpersonal, and transpersonal). Palliative care professionals face a lack of training and insufficient preparation to deliver spiritual care. Spiritual care competence depends on professional spiritual development and experience, spiritual intelligence (cognitive), spiritual humility (affective), and having a critical and reflexive mind (functional). In the future, palliative care should seek to improve competent spiritual care. This review could help clarify the real configuration of competent spiritual care and lead to improvements in a professional's empowerment when delivering effective spiritual care to patients and families.

Death anxiety and religiosity in a multicultural sample: a pilot study examining curvilinearity, age and gender in Singapore.

This study investigated the association between multidimensional death anxiety and religiosity in multicultural Singapore by examining potential variations by age and gender. We also explored the possibility of a curvilinear effect, where highly religious or non-religious individuals report lower death anxiety than moderately religious people, forming an inverted U-curve pattern. Data were collected from 110 participants using questionnaires that assessed death anxiety and religiosity. Parametric and non-parametric tests were then conducted. The findings showed that women had significantly higher death anxiety and religiosity than men, and highly and moderately religious people had significantly higher death anxiety than non-religious people. People of all age groups had similar levels of death anxiety. These findings highlight the importance of developing targeted death anxiety interventions that integrate spiritual aspects in Singapore so that clinicians can provide culturally competent care.

Experiences of Practical Nurses in Promoting the Rehabilitation of the Elderly and Their Education – A Secondary Publication

The significance of rehabilitation-promoting nursing care is emphasized in aging Finland. According to studies, rehabilitation-promoting nursing care enhances the functional capacity of the elderly. The Elderly Services Act obliges municipalities to create a plan to support the elderly population, emphasizing home care and rehabilitation measures. A large portion of graduated practical nurses will be working with the elderly, so the education of practical nurses must meet the needs of the workforce. The study aimed to produce new information on the implementation of rehabilitation-promoting nursing care in the elderly service system and on the education of rehabilitation-promoting nursing care for the elderly in vocational institutions. The research data was collected in the autumn of 2020 through individual thematic interviews with practical nurse students (n = 8). The data was analyzed using inductive content analysis. Practical nurse students’ experiences of rehabilitation-promoting nursing care for the elderly were related to nurses’ time management, organizational practices, nursing competence, nurses’ attitudes, nurses’ practices, organizational development, implementation and development of practical education, factors affecting the use of aids, and technological aspects of aids in the future. In conclusion, it can be stated that the content of education and practical work life do not align. It is essential to increase competence in rehabilitation-promoting nursing care and to develop organizational practices.

Perceptions of spirituality and predictors of competence in spiritual care among nursing students in five middle eastern countries: A cross-sectional survey

BackgroundSpiritual Care is integral to holistic nursing; however, it often remains underprovided due to a lack of education. ObjectiveThis study examined perceptions of spirituality and predictors of competence in spiritual care among nursing students in Middle Eastern countries. DesignA cross-sectional survey was used. Participant/settingNursing students (n = 785) from five universities in Middle Eastern countries were included. MethodsParticipants completed the Spiritual Care-Giving Scale-Arabic and Spiritual Care Competency Scale. Multiple linear regression analysis was used to identify the predictors of perceived competence in spiritual care. ResultsNursing students showed positive attitudes towards spirituality, with a mean score of 5.1 (SD = 0.60) on the Spiritual Care-Giving Scale-Arabic. However, their perceived competence in providing spiritual care was low to moderate with a mean score of 79.0 (SD = 32.0) on the Spiritual Care Competency Scale. The bivariate analysis indicated significant relationships between students' spiritual care competence and gender, previous exposure to spirituality education, willingness to undergo spirituality training, and total spirituality score. Finally, significant predictors of higher competence included regular admission status, prior spiritual education, willingness to undergo spiritual care training, and higher personal spirituality scores. ConclusionNursing students in the Middle East have positive attitudes towards spirituality, but low to moderate competence in providing spiritual care. The influence of personal spirituality on competence underscores the importance of fostering a supportive environment for students to reflect on their beliefs. Comprehensive curriculum revisions and training programs, along with the recognition of the impact of personal spirituality, are essential to prepare future nurses for holistic people's care.

Improving Knowledge and Competency in Gender-Affirming Patient Care Among New Nurses in Sexual and Reproductive Health Care

ObjectiveTo improve knowledge and competency in providing gender-affirming patient care among newly licensed registered nurses (RNs) working in sexual and reproductive health (SRH). DesignPilot, pretest/posttest, descriptive design. Setting and ParticipantsParticipating RNs were employed at a large academic health center in the southeastern United States. All RNs were providing SRH nursing and participating in the health center’s new nurse residency program. Methods and InterventionParticipants completed an online synchronous training that introduced topics such as sex versus gender, gender dysphoria, and health disparities. This education was followed by in-person training, where an unfolding case study applied concepts to theoretical patient scenarios specific to reproductive health. Participants completed a 20-item survey with a single assessment retrospective pre–post design to measure change in knowledge and competency. ResultsTwelve RNs participated in this pilot study. Fewer than half had previously received instruction on providing care to trans∗ persons. Seven self-perceived knowledge and competency areas were evaluated with paired retrospective pre–post design questions. All areas measured showed increases from pretraining to posttraining. Participants also had the opportunity to respond to open-ended questions. Common themes identified in these responses include participants planning to maintain a greater awareness and intentionality with language and abandoning cisgender assumptions. Several participants also described health care–specific systemic barriers that could prevent a trans∗ patient from feeling comfortable. ConclusionProviding new graduate nurses with education specific to trans∗ patients may help them to feel more knowledgeable and competent when caring for these individuals in SRH settings.

Measurement of palliative care competencies using PALCOM instrument

Introduction: An essential component of any profession is competent and confident staff. In palliative care, a wellrounded approach and versatile knowledge of staff and students are of great importance. Measuring these competencies is very important for the development of palliative care and health care. Methods: Measurement of competencies in palliative care by analyzing existing instruments and questions in palliative care. Process of developing a new instrument for measurement of competencies in palliative care PALCOM, using cross-sectional methodology with nurses from Bosnia and Herzegovina. Results: The results are presenting findings of research done with nurses from BIH using two main variables: Years of work experience and level of education of the participants. Main difference is between the two competencies: Pain assessment and management, education, and care for the patient’s family regarding the level of education. Conclusion: The need for measuring competencies is evident in the daily evolution of palliative care, community-based palliative care, hospice care, and subspecialized palliative care. There is no questionnaire that can measure all competencies, but the use of the general competencies in the PALCOM questionnaire can cover this area with the measurement of different domains and the competencies specific to these domains.

Midwives Responding to the Needs of Uninsured Clients: Old Order and New Immigrant Women in Midwifery Care

The funding structure of midwifery in Ontario enables midwives to provide care to women without provincial health care coverage. This article explores midwives’ experiences in providing care to two key groups of women without provincial insurance: 1) women who lack coverage as a result of their precarious immigration status, and 2) women who opt out of publicly funded health insurance for religious reasons. Data from 15 interviews with midwives who serve these communities reveal several important themes that shape their experiences. Further, as midwives adapt their practice to work with communities of uninsured women, their goal of providing culturally competent midwifery care to more diverse groups of women becomes actualized.

The Experiences of Practical Nurse Students in Promoting the Rehabilitation of the Elderly Through Nursing Care and Its Education – A Secondary Publication

The significance of rehabilitation-promoting nursing care is emphasized in aging Finland. According to studies, rehabilitation-promoting nursing care enhances the functional capacity of the elderly. The Elderly Services Act obliges municipalities to create a plan to support the elderly population, emphasizing living at home and rehabilitative measures. A large portion of graduated practical nurses will be working with the elderly, so the education of practical nurses must meet the needs of the workforce. The study aimed to produce new information on the implementation of rehabilitation-promoting nursing care in the elderly services system and on the education of rehabilitation-promoting nursing care for the elderly in vocational institutions. The research data was collected in the fall of 2020 through individual theme interviews with practical nurse students (n = 8). The data was analyzed using inductive content analysis. The experiences of practical nurse students regarding rehabilitation-promoting nursing care for the elderly were related to nurses’ time management, organizational practices, nurses’ competence, nurses’ attitudes, nurses’ methods of operation, organizational development, implementation and development of practical teaching, factors affecting the use of aids, and the technology of aids in the future. In conclusion, it can be stated that the content of education and practical work life do not align. It is essential to increase competence in rehabilitation-promoting nursing care and develop organizational practices.

Serving Those Who Served: Enhancing Colorectal Surgery Care for Veterans

AbstractThe Department of Veterans Affairs (VA) is the largest provider of integrated health care services in the United States and its mission is to honor veterans by providing timely, effective, and high-quality health care that improves individuals' health and functionality. The VA provides comprehensive primary and specialty care, including colorectal surgery services, to eligible veterans who suffer from a disproportionately high burden of medical comorbidities and often belong to vulnerable populations, including individuals of low socioeconomic status, those who identify as lesbian, gay, bisexual, transgender, and questioning, racial minorities, and those suffering from severe mental health illness. There are many challenges to caring for a population of veterans with benign and malignant colorectal disease due to both patient and system level factors. Despite these challenges, the VA has demonstrated a commitment to ensuring culturally competent, equitable, and inclusive care and to conducting research that establishes evidence-based best practices in the management of colorectal diseases. These efforts have led to outcomes for patients undergoing care for colorectal diseases within the VA that are par with or better than civilian outcomes. The VA is uniquely positioned on a system level to provide nationwide efforts that improve care delivery and serve those who served.

Bringing a Structural Competency Framework to the (Simulated) Bedside: The Premature Discharge Objective Structured Clinical Exam.

Structural competency is increasingly valued as a framework to address health equity within undergraduate medical education. As of academic year 2023-2024, the Liaison Committee on Medical Education (LCME) requires that medical schools have content regarding basic principles of structurally competent health care. Despite encouraging data about the effectiveness of structural competency curricula, most occur within the walls of a classroom and do not enter the authentic or simulated clinical space. From 2022 to 2023, an objective structured clinical exam (OSCE) focused on premature discharge, previously known as discharge against medical advice, was integrated into the required fourth-year Health Policy course at Weill Cornell Medical College, which uses the framework of structural competency. After a simulated clinical encounter, students completed a reflection assignment and participated in group debriefing to reflect on how policy coursework affected their simulated clinical experience. Students completed an evaluation about their OSCE experience, and OSCE checklist performance was analyzed. Of 82 students who participated in the curriculum, 68 completed a curricular evaluation, and 62 consented to have their OSCE performance evaluated for research. Mean overall OSCE checklist performance evaluating students' patient-centered communication skills, harm reduction skills, and discharge planning and counseling was 14.3/16 (89.6%; standard deviation, 9.8%). Students reported it was valuable to focus on structural factors affecting care within the simulated clinical encounter by using the structural competency framework. To the authors' knowledge, this is the first OSCE for medical students designed to deepen their understanding of structural competency by embedding the experience into an existing course using the framework. Future work should explore how this curriculum affects students' attitudes toward structurally vulnerable patients. With structural competency as an LCME requirement, the use of OSCEs may give educators a means to teach and assess fundamental concepts.

Core competencies in palliative care among oncology nurses: An observational study

BACKGROUND: Palliative care requires a collaborative approach from a multidisciplinary team, incorporating nurses with ethical, clinical, communicative-relational, psychosocial, and teamwork skills. However, many professionals feel unprepared to face end-of-life challenges, highlighting a lack of skills, especially regarding psychosocial and spiritual aspects. AIM: The purpose of this study is to explore nurses' self-perception of competencies in palliative care. METHODS: A single-center descriptive observational study was conducted among palliative and non-palliative care nurses at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan (INT), using the short Italian version of the Professional Competence Scale (PCSQ). The Kruskal-Wallis test was used along with multivariate ANOVA for statistical analysis. RESULTS: 122 nurses participated (response rate: 52%), predominantly women (78%), aged 25-34 (50%), with a degree (46%) and over 10 years of experience (41%). The majority had no experience (71%) in palliative care, while 16% were currently working in this field. Statistical analysis revealed no significant correlations between educational level and responses. The Kruskal-Wallis test showed that experience in palliative care significantly influenced self-assessment scores, such as in activating non-pharmacological management strategies (p=0.004). CONCLUSIONS: Nurses perceive high competence in ethical and clinical decision-making in palliative care, influenced more by experience than by training. Addressing patients' subjective needs and using non-pharmacological interventions remain a challenge for nurses not working in palliative care settings.

Competent care during pregnancy loss

All nurses should be prepared to meet the needs of these patients.

Behavioral Health Access and Workforce Competence for Integrated Care: Highlighting Interprofessional Initiatives from Two North Carolina Social Work Programs.

Effective team-based care is necessary for implementation of the integrated care models recommended to improve behavioral health access. Many models rely on social work-ers who are trained to deliver behavioral health care as an interprofessional team member. In this article, we highlight two social work programs utilizing interprofessional educa-tion to enhance team-based care competence.