Competent Care Research Articles

Nursing care competencies for multiple sclerosis

The UK Multiple Sclerosis Specialist Nurse Association's competency document, which was originally developed in 2008, aims to educate and increase awareness of multiple sclerosis among both specialist nurses and other non-specialist professionals. The latest document—revised in 2024—aims to showcase the most up-to-date information and serves not only as daily practice guidelines, but also promotes safe and effective practice in multiple sclerosis care.

Mapping an undergraduate medical education curriculum against national and international palliative care reference learning objectives

BackgroundThe teaching of palliative care competencies is an essential component of undergraduate medical education. There is significant variance in the palliative care content delivered in undergraduate medical curricula, revealing the utility of reference standards to guide curricular development and assessment. To evaluate our university’s undergraduate palliative care teaching, we undertook a curriculum mapping exercise, comparing official learning objectives to the national Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC) and the international Palliative Education Assessment Tool (PEAT) reference objectives.MethodsMultiple assessors independently compared our university’s UGME learning objectives with EFPPEC and PEAT reference objectives to determine the degree-of-coverage. Visual curriculum maps were created to depict in which part of the curriculum each objective is delivered and by which medical specialty.ResultsOf 122 EFPPEC objectives, 55 (45.1%) were covered fully, 42 (34.4%) were covered partially, and 25 (20.5%) were not covered by university objectives. Of 89 PEAT objectives, 40 (44.9%) were covered fully, 35 (39.3%) were covered partially, and 14 (15.7%) were not covered by university objectives.ConclusionsThe majority of EFPPEC and PEAT reference objectives are fully or partially covered in our university’s undergraduate medical curriculum. Our approach could serve as a guide for others who endeavour to review their universities’ specialty-specific medical education against reference objectives. Future curriculum development should target the elimination of identified gaps and evaluate the attainment of palliative care competencies by medical learners.

Midwifery of the Future: A Widening Field of Competences

The field of midwifery has been developing rapidly, reflecting the changing landscape of healthcare and the different needs of anticipating mothers and their classifications. Midwifery, which formerly generally guided labor, has expanded into an inclusive rule of competence that extends far beyond the delivery room. This conversion is designed to meet the complete healthcare needs of mothers throughout their generative journey from prejudice to postpartum. Modern midwives are progressively being acknowledged as basic healthcare providers who offer care continuation. They carry an extended collection of competencies, encompassing not only reproductive support but also gynecological care, birth control, intercourse well-being education, and menopausal support. Midwives have adapted to different educational circumstances, forging alliances with obstetricians, nurses, and additional healthcare professionals to ensure logical woman-centered care. In terms of mathematical health, midwives influence electronics to support telehealth duties, monitor high-risk pregnancies by chance, and offer approachable instruction and support through traveling apps and platforms. This enlarging field of competencies involves a powerful emphasis on mental well-being, as midwives play a critical role in labeling perinatal mood disorders and providing psychological support to wives. Furthermore, midwifery has taken up evidence-based practices, fostering an education of research and novelty. Midwives help with the implementation of best practices, ensuring first-rate care of their cases. They undertake constant education, stop next to new healing advancements, and maintain their guidance abilities to advocate for mothers' well-being and reproductive rights. As midwifery continues to progress, cooperation with healthcare providers, policymakers, and society is essential. By admitting the extending competencies of midwives, we can ensure that girls endure inclusive, sympathetic, and mankind’s welfare and competent care during the whole of their generative journey, forming the future of midwifery as a necessary component of modern healthcare.

Implementation of remote home care: assessment guided by the RE-AIM framework

BackgroundWelfare technology interventions have become increasingly important in home-based palliative care for facilitating safe, time-efficient, and cost-effective methods to support patients living independently. However, studies evaluating the implementation of welfare technology innovations are scarce, and the empirical evidence for sustainable models using technology in home-based palliative care remains low. This study aimed to report on the use of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess the implementation of remote home care (RHC) a technology-mediated service for home-living patients in the palliative phase of cancer. Furthermore, it aimed to explore areas of particular importance determining the sustainability of technologies for remote palliative home-based care.MethodsA secondary analysis of data collected by semi-structured interviews with patients with cancer in the palliative phase, focus groups, and semi-structured interviews with healthcare professionals (HCPs) experienced with RHC was performed. A deductive reflexive thematic analysis using RE-AIM dimensions was conducted.ResultsFive themes illustrating the five RE-AIM dimensions were identified: (1) Reach: protective actions in recruitment - gatekeeping, (2) Effectiveness: potential to offer person-centered care, (3) Adoption: balancing high touch with high tech, (4) Implementation: moving towards a common understanding, and (5) Maintenance: adjusting to what really matters. The RE-AIM framework highlighted that RHC implementation for patients in the palliative phase of cancer was influenced by HCP gatekeeping behavior, concerns regarding abandoning palliative care as a high-touch specialty, and a lack of competence in palliative care. Although RHC facilitated improved routines in patients’ daily lives, it was perceived as a static service unable to keep pace with disease progression.ConclusionsA person-centered approach that prioritizes individual needs and preferences is necessary for providing optimal care. Although technologies such as RHC are not a panacea, they can be integrated as support for increasingly strained health services.

The holistic nursing competence and transition shock of newly graduated nurses as the determinants of missed nursing care: The mediation analysis.

To investigate the determinants of missed nursing care and to analyse the mediating effect of holistic nursing competence on the relationship between transition shock and missed nursing care. Transition shock of newly graduated nurses is associated with missed nursing care. Previous studies have shown the determinants of missed nursing care among nurses, but little is known about the relationship between missed nursing care, transition shock and holistic nursing competence. Descriptive and correlational design. The study was conducted among newly graduated nurses (n = 201) working in acute care hospitals for 1-12 months. The MISSCARE survey, Holistic Nursing Competence Scale and Nursing Transition Shock Scale were used for data collection, in addition to a sociodemographic question form. Data were analysed using Pearson correlation, multiple regression and mediation analyses. The study was reported following the STROBE checklist. The determinants of missed nursing care among newly graduated nurses were sex, unit type, rotating shift work, holding a certificate, holistic nursing competence and transition shock. All these variables explain 35% of the variance in missed nursing care. Holistic nursing competence directly mediated 51.7% of the relationship between transition shock and missed nursing care. Holistic nursing competence may decrease missed nursing care by reducing the effects of transition shock on newly graduated nurses. The study highlighted that newly graduated nurses are an important population regarding missed nursing care. The determinants of missed care should be considered in the nursing care delivery to prevent missed care by newly graduated nurses. Based on the study findings, some recommendations were made for nurse managers and faculty for the orientation program and undergraduate nursing education.

Into the looking glass on cultural and religious competent care: optimizing healthcare for Haredi individuals with mental illness

Previous research has shown that minority groups tend to underuse healthcare services. One community whose experiences remain particularly under-researched in the Western world is Haredi Jews- a diverse group of individuals committed to traditional Talmudic and Halakhah teachings and observances. This presentation aims to enhance participants' understanding of mental health-seeking behaviours and challenges faced by Haredi individuals. We conducted a qualitative study that involved in-depth interviews with 24 adults who identified as Haredi and used mental health services, as well as informal consultations with local rabbis and community leaders. Interviews were transcribed and analyzed using thematic analysis techniques. Analysis revealed several important themes, including: (1) Strength of religious practices, community, and relationship with God as a factor determining mental well-being. (2) Implications of devotion to religion within the patient-physician encounter. (3) Stigma and acknowledged lack of awareness surrounding mental health in Haredi communities. These themes will be explored in the presentation, which will aim to bring light to participants’ lived experiences. We hope to address the proverbial "elephant in the room" often ignored or overlooked, as encountered by Haredi community members and their interactions with the healthcare system. We will present the unique strengths and challenges related to mental health encountered by Haredi Jews in our study, while discussing potential measures that can produce better health outcomes and culturally sensitive care for Haredi individuals.

How can countries respond to the health and care workforce crisis? Insights from international evidence.

Future global health security requires a health and care workforce (HCWF) that can respond effectively to health crises as well as to changing health needs with ageing populations, a rise in chronic conditions and growing inequality. COVID-19 has drawn attention to an impending HCWF crisis with a large projected shortfall in numbers against need. Addressing this requires countries to move beyond a focus on numbers of doctors, nurses and midwives to consider what kinds of healthcare workers can deliver the services needed; are more likely to stay in country, in rural and remote areas, and in health sector jobs; and what support they need to deliver high-quality services. In this paper, which draws on a Policy Brief prepared for the World Health Organization (WHO) Fifth Global Forum on Human Resources for Health, we review the global evidence on best practices in organising, training, deploying, and managing the HCWF to highlight areas for strategic investments. These include (1). Increasing HCWF diversity to improve the skill-mix and provide culturally competent care; (2). Introducing multidisciplinary teams in primary care; (3). Transforming health professional education with greater interprofessional education; (4). Re-thinking employment and deployment systems to address HCWF shortages; (5). Improving HCWF retention by supporting healthcare workers and addressing migration through destination country policies that limit draining resources from countries with greatest need. These approaches are departures from current norms and hold substantial potential for building a sustainable and responsive HCWF.

Health Equity and Policy Considerations for Pediatric and Adult Congenital Heart Disease Care among Minoritized Populations in the United States.

Achieving health equity in populations with congenital heart disease (CHD) requires recognizing existing disparities throughout the lifespan that negatively and disproportionately impact specific groups of individuals. These disparities occur at individual, institutional, or system levels and often result in increased morbidity and mortality for marginalized or racially minoritized populations (population subgroups (e.g., ethnic, racial, social, religious) with differential power compared to those deemed to hold the majority power in the population). Creating actionable strategies and solutions to address these health disparities in patients with CHD requires critically examining multilevel factors and health policies that continue to drive health inequities, including varying social determinants of health (SDOH), systemic inequities, and structural racism. In this comprehensive review article, we focus on health equity solutions and health policy considerations for minoritized and marginalized populations with CHD throughout their lifespan in the United States. We review unique challenges that these populations may face and strategies for mitigating disparities in lifelong CHD care. We assess ways to deliver culturally competent CHD care and to help lower-health-literacy populations navigate CHD care. Finally, we review system-level health policies that impact reimbursement and research funding, as well as institutional policies that impact leadership diversity and representation in the workforce.

Enhancing interprofessional education readiness in undergraduate dental students: a scenario-based peer learning programme.

Interprofessional Education (IPE) is an educational approach that brings together students from different healthcare professions to foster collaborative learning and teamwork. Before integrating IPE into the curriculum of health preprofessional students, it is necessary to increase their readiness for IPE. Dentistry increasingly values interprofessional collaboration and teamwork for enhanced patient care and healthcare team competencies, an emphasis also echoed by recent dental education authorities. The aim of this quasi-experimental research was to assess the influence of Scenario Based Learning Peer Learning (SBPL) programme, which involved scenarios necessitating interprofessional communication, on the readiness for IPE among a cohort of undergraduate dental students studying within the framework of the European Higher Education Area (EHEA). This study investigates undergraduate dental students' readiness for IPE and the influence of SBPL programme on their readiness. Participants (n = 25) from 18 EHEA countries completed the Readiness for Interprofessional Learning Scale(RIPLS) before and after SBPL programme, held at the 70th European Dental Students' Association (EDSA)meeting. Data were analyzed using the Wilcoxon Signed Rank Test (p = 0.05). After the SBPT programme, there was a statistically significant increase (p < 0.05) in the mean of the total scale, teamwork and collaboration, roles and responsibilities and professional identity subscale. In general, SBPL programme showed a constructive effect on interprofessional readiness. Although there was no statistically significant increase only in items 9,12,18 of the 19 items of the RIPLS, there was an increase in the averages in all except item 12. Our research emphasizes the importance of diverse perspectives and IPE in the realm of dental education. Within the limits of this study, it showcases the efficacy of a brief half-day SBPL programme with interprofessional scenarios in enhancing participants' readiness. The programme notably enhanced dental students' readiness in grasping crucial aspects of IPE: teamwork and collaboration, professional identity, and roles and responsibilities. However, this study does not delve into the potential impact of a comprehensive, long-term curriculum integrating IPE principles. This gap underscores the need for further exploration into the sustained influence of IPE on the interprofessional skills of dental school graduates.

The impact of a nursing spiritual care module on nursing competence: an experimental design

PurposeThis study aimed to assess the impact of the Nursing Spiritual Care Module on the competence of nurses in providing spiritual care in the context of Malaysia.MethodThis study employed an experimental design and involved a total of 122 nurses, with 59 in the experimental group and 63 in the control group. Participants were selected from palliative care wards associated with Hospital Universiti Sains Malaysia. Nurses in the experimental group underwent a two-week educational module on nursing spiritual care, while nurses in the control group attended a single lecture on spiritual care provided by the hospital.ResultsThe results indicated no significant differences in sociodemographic characteristics between the two groups. A significant difference in spiritual care competence within the intervention group and the control group over time (p-value = 0.001), between the two groups (p-value = 0.038), and in the interaction between time and group (p-value = 0.001).ConclusionThe Nursing Spiritual Care Module is crucial in aiding nurses and healthcare professionals in cultivating the appropriate and wholesome attitudes and practices necessary to address the spiritual needs of patients.

The Delirium Objective structured clinical examination Education (DOE) Pilot Study: implementation of the delirium OSCE education package within hospital education for registered healthcare professionals.

Objectives To evaluate an interactive delirium educational intervention on confidence and competence in delirium assessment tools and delirium knowledge; delirium knowledge scores; clinical practice; planned practice change and perceived usefulness of the education. Methods We conducted a quasi-experimental pilot study, with qualitative follow-up, at two metropolitan hospital sites in Australia. Participants were active registered healthcare practitioners. Survey data were collected pre (T0) and six weeks after the educational intervention (T1). Scores were derived from the seven-item OSCE marking rubric (maximum 15). At T1, observations of delirium care in practice were undertaken using a 10-item (maximum 12) tool. Results There was a significant increase in perceptions of confidence and competence in using delirium assessment tools and knowledge (p&lt;0.001). Delirium knowledge scores improved significantly from 13.6 (SD 1.7) at baseline to 14.6 (SD 1.1) at T1(p&lt;0.001). The high level of competency in delirium care demonstrated and gained during the OSCE (88.7%, SD 0.1) was translated and maintained into clinical practice (81.5%, SD 0.1) (p=0.07). Open-ended survey responses generated three themes: (1) Assess for Delirium, (2) The usefulness of The Delirium OSCE Package and, (3) A need for ongoing education on delirium care. Conclusion This study generated evidence on integrating The Delirium OSCE Education Package in other clinical settings and private hospital sites. Following this pilot study, a RCT was designed using the tools and methods developed to evaluate the effectiveness of The Delirium OSCE Education Package against conventional professional development education.

Medical students' perceptions on preparedness and care delivery for patients with autism or intellectual disability.

To provide competent care to patients with autism spectrum disorder (ASD) or intellectual developmental disorder (IDD), healthcare professionals must recognize the needs of neurodivergent populations and adapt their clinical approach. We assessed the perceived preparedness of medical students to adapt care delivery for patients with ASD/IDD, as well as their perceptions on neurodiversity education. We conducted a sequential explanatory mixed-methods study on undergraduate medical students at McGill University during the academic year 2020-2021. We administered an online survey, followed by semi-structured interviews. We analyzed data using descriptive statistics and thematic analysis. We integrated findings at the interpretation level. We included two-hundred-ten survey responses (~29% of class), and 12 interviews. Few students felt prepared to adjust care for patients with ASD/IDD despite most indicating doing so was important. Ninety-seven percent desired more training regarding care accommodation for neurodivergent patients. Thematic analysis unveiled the perception of current insufficient education, and the value of experiential learning. This study highlights low perceived preparedness of medical students to accommodate care for neurodivergent patients, and a desire for more instruction. Incorporating interactive training in medical school curricula regarding modifying care delivery for neurodivergent individuals may improve the perceived preparedness of medical trainees to work with these patients and care quality.

Exploring the Effectiveness of a Prenursing Introductory Course: Experiences of Culturally Diverse Nursing Students

Abstract Greater ethnic and racial diversity in the nursing profession is needed to reduce health care disparities and provide culturally competent health care to an increasingly diverse patient population. Prenursing preparation and early intervention programs have been developed to reduce attrition among culturally diverse students. A basic qualitative study was conducted to answer how culturally diverse students describe their experiences in a prenursing introductory course, part of a rigorous bachelor of nursing program at a historically Black university. An inductive thematic analysis revealed that students considered the course too easy; the course contributed to first-semester success.

Optimizing care for patients with infectious diseases: Roles of emergency medical services and nursing

Background: Internal medicine (IM) and its subspecialties have seen a shift in care delivery, increasingly relying on nonphysician practitioners (NPPs) such as nurse practitioners (NPs) and physician assistants (PAs). This article focuses on the development of a curriculum and competency framework for advanced care practitioners (ACPs) specializing in infectious diseases (ID). Aim: To establish a comprehensive competency-based education (CBE) model for NPs and PAs in ID, aiming to enhance their skills and optimize patient care. Methods: The framework incorporates six core competencies endorsed by various regulatory and professional organizations. An interprofessional approach was utilized to develop a curriculum that addresses the educational needs of ACPs in ID practice, along with assessing Entrustable Professional Activities (EPAs). Results: The proposed guidelines outline specific clinical responsibilities and milestones for ACPs over a one-year training period. This structured approach ensures that ACPs develop competencies in patient care, medical knowledge, interpersonal skills, professionalism, and systems-based practice, allowing them to effectively manage common and complex infectious diseases. Conclusion: The integration of ACPs into infectious disease practice is vital for enhancing patient care and alleviating resident workload.

Application of mobile games in the formation of health care competence of students of higher educational institutions

A serious game is a type of game that is designed for a primary purpose other than entertainment. Instead, serious games are intended to achieve specific goals, such as education, training, or health promotion. The goal of serious games is to engage players in a way that is both enjoyable and effective in achieving the intended learning or behavior change outcomesю. The article substantiates the importance of mobile games in the formation of personal qualities and health-preserving competence of students of higher educational institutions. The content of such concepts as "motor activity", "health-preserving competence", "game", "gaming activity" was analyzed. Emphasis is placed on the fact that a mobile game should be used to consolidate movements. In the course of the article, the main forms of organization of the motor activity mode of students of higher educational institutions were determined, the influence of games on student development was shown, the role of organizing mobile games was revealed, the importance of mobile games in the life of students of higher educational institutions was conside red, and their pedagogical characteristics were given. The structure of pedagogical guidance with student gaming activities in the educational process of a higher educational institution is presented, and approaches to the classification of mobile games are also described.

Developing the Workforce of the Digital Future: mHealth Competency and Fidelity Measurement in Community-Based Care

Integrating mobile health (mHealth) interventions into settings that serve diverse patient populations requires that prerequisite professional competencies are delineated and that standards for clinical quality assurance can be pragmatically assessed. Heretofore, proposed mHealth competencies have been broad and have lacked a framework to support specific applications. We outline the meta-competencies identified in the literature relevant to mHealth interventions and demonstrate how these meta-competencies can be integrated with population- and intervention-related competencies to help guide a pragmatic approach to competency assessment. We present a use case based on FOCUS—an evidence-based mHealth intervention designed for individuals with serious mental illness and currently being implemented in geographically and demographically diverse community behavioral health settings. Subsequent to identifying the cross-cutting competencies relevant to the target population (outpatients experiencing psychotic symptoms), substratal intervention (Cognitive Behavioral Therapy for psychosis), and treatment modality (mHealth), we detail the development process of an mHealth fidelity monitoring system (mHealth-FMS). We adhered to a published sequential 5-step process to design a fidelity monitoring system that aligns with our integrated mHealth competency framework and that was guided by best practices prescribed by the Treatment Fidelity Workgroup of the National Institutes of Health Behavior Change Consortium. The mHealth-FMS is intended to enhance both clinical and implementation outcomes by grounding the mHealth interventionist and the system of care in which they operate in the core functions, tasks, knowledge, and competencies associated with system-integrated mHealth delivery. Future research will explore acceptability and feasibility of the mHealth-FMS.

The development of kinaesthetic competence in acute inpatient care: a feasibility study with a pre-posttest design

The development of kinaesthetic competence in acute inpatient care: a feasibility study with a pre-posttest design Abstract: Background: Most patients in acute care hospitals experience movement limitations due to surgery or a general deterioration of their condition. Therefore, nurses need a high level of competence in movement promotion. Aim: The aim of this study was to evaluate the feasibility of a three-day advanced kinaesthetics training course followed by six months of practical support to promote kinaesthetic competence in inpatient acute care and the competence development achieved as a result. Methods: The evaluation of the nurses' effectiveness was conducted using a pre- and post-measurement of kinaesthetic competence through a self-assessment questionnaire and an observation protocol. The evaluation of feasibility was done through a semi-structured questionnaire. Results: Eight nurses rated their kinaesthetics competence as good before (mean: 10,8 on a scale of 4-16) and very good after the intervention (mean: 13,2). The kinaesthetics trainer assessed the competence before as sufficient (mean: 9,4 on a scale of 4-16) and very good (mean: 14,5) after the practical support. The need to make practical support more flexible is highlighted in the qualitative data. Conclusion: The results demonstrate that a three-day training followed by six months of practical support has a positive impact on nurses' kinaesthetic competence.

Effect of a Spiritual Care Training Program to Build Knowledge, Competence, Confidence and Self-awareness Among Australian Health and Aged Care Staff: An Exploratory Study.

The aim of this study was to evaluate a new spiritual care training program with health and aged care staff. A four-module program was delivered to 44 participants at a large Catholic health and aged care provider in Australia. Pre, post and 6week follow-up surveys were administered and included measures of spiritual care competency, confidence, perspectives of spirituality and spiritual care, spiritual well-being, and satisfaction. Paired sample t-tests showed total scores of participants' spiritual well-being, spiritual care competency and confidence significantly improved following the training and were largely maintained at follow-up. Perspectives on spirituality and spiritual care did not significantly change over time.

Exploring the Impact of Gender Bias Among Medical Trainees.

Research has suggested that health care providers are not immune to implicit and explicit gender bias among their own colleagues and in the treatment of patients. To date, limited research examines gender bias in trainees and how that bias might intersect with patient care. Our study focused on gendered expectations, perceived competence of medical providers, and perceived acceptability of patients who advocate for themselves. We used a 2x2x2x2 mixed design to examine the impact of participant gender, type of physical exam (vaginal vs elbow), trainee status, and gender of vignette physician. Participants read and responded to vignettes depicting various standardized clinical scenarios. The complete sample included 342 participants from a rural medical teaching hospital and a private liberal arts college in the same geographic region. Findings suggested a significant interaction between physicality and gender of the participant on perceived competence. Although males and females had similar ratings of competence on an exam with low physicality (elbow), the data suggested that males did not recognize how errors during clinical practice may impact a hypothetical female patient. Future research might examine interventions that aim to increase awareness of gender bias among medical trainees and to explore whether interventions might improve patient care and perceptions of competence following identified errors.

Educating Social Workers in Palliative and End-of-Life Care: Development and Implementation of a New National Training Program.

Background: Educating Social Workers in Palliative and End-of-Life Care (ESPEC) is a nationally scalable continuing education program designed to improve the knowledge and skills of frontline health social workers caring for patients with serious illness. Objectives: This article describes ESPEC's rationale, development, and initial implementation. Design: Following the creation of consensus-derived core primary palliative care competencies for health primary care social workers based on the eight domains of palliative care outlined in the National Consensus Project Guidelines for Quality Palliative Care, an evidence-based curriculum was developed. This was used to develop a hybrid training model with a self-study component, synchronous instructor-led skills-based training, leadership training, and mentorship. The interactive curriculum incorporates patient scenarios highlighting the health social work role. Training targets high-impact skills-the biopsychosocial-spiritual assessment, advance care planning, family meetings, and interprofessional communication-and professional development. Settings/Subjects: ESPEC was launched in the United States in collaboration with the National Association of Social Workers (NASW) and the Social Work Hospice and Palliative Care Network (SWHPN). Results: The preliminary launch demonstrated high user acceptability, positive ratings for content and format, and gains in knowledge and competence. Conclusions: Data suggest that ESPEC can increase health social workers' knowledge and confidence as providers of palliative care interventions. National dissemination is ongoing.