Nursing Competency Assessment Research Articles

A many-facet Rasch measurement model approach to investigating objective structured clinical examination item parameter drift.

Objective Structured Clinical Examinations (OSCEs) are widely used for assessing clinical competence, especially in high-stakes environments such as medical licensure. However, the reuse of OSCE cases across multiple administrations raises concerns about parameter stability, known as item parameter drift (IPD). AIMS &OBJECTIVES: This study aims to investigate IPD in reused OSCE cases while accounting for examiner scoring effects using a Many-facet Rasch Measurement (MFRM) model. Data from 12 OSCE cases, reused over seven administrations of the Internationally Educated Nurse Competency Assessment Program (IENCAP), were analyzed using the MFRM model. Each case was treated as an item, and examiner scoring effects were accounted for in the analysis. The results indicated that despite accounting for examiner effects, all cases exhibited some level of IPD, with an average absolute IPD of 0.21 logits. Three cases showed positive directional trends. IPD significantly affected score decisions in 1.19% of estimates, at an invariance violation of 0.58 logits. These findings suggest that while OSCE cases demonstrate sufficient stability for reuse, continuous monitoring is essential to ensure the accuracy of score interpretations and decisions. The study provides an objective threshold for detecting concerning levels of IPD and underscores the importance of addressing examiner scoring effects in OSCE assessments. The MFRM model offers a robust framework for tracking and mitigating IPD, contributing to the validity and reliability of OSCEs in evaluating clinical competence.

Reliability of the Mental Health Nurse Competency Assessment Tool (ECOEnfSM): A pilot study

AimTo evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice. MethodA pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient). ResultsThe Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (P < .01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (P < .01). All UCs showed a good to excellent consistency (r > 0.80). The “Home Visits” assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it. ConclusionThe ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

Fiabilidad de la escala de Evaluación de Competencias Enfermeras en Salud Mental: estudio piloto

AimTo evaluate the reliability of the ECOEnfSM scale as a tool to assess the professional competencies of Mental Health Nurse Practitioners (MHNP) in their clinical practice. MethodA pilot study, observational, descriptive and cross-sectional, focuses on MHNP who have completed their Specialized Health Training Program (SHTP) in Spain. The data were collected by general and collaborators mentors of the Multiprofessional Teaching Units (MTUs). The Mental Health Nursing Competency Assessment Tool (ECOEnfSM) was used, which consists of three subscales and eight Competence Units (CU). A reliability and validity analysis were conducted (Cronbach's alpha and Spearman's correlation coefficient). ResultsThe Rotation Assessment subscales showed excellent reliability (r > 0.90) with high and very high correlations (r > 0.6) in all UCs with high levels of significance (p <0.01). The Annual Assessment subscale showed good reliability (r > 0.80) with a medium and very high correlation (r > 0.4) with high levels of significance (p <0.01). All UCs showed a good to excellent consistency (r > 0.80). The “Home Visits” assessment criterion showed heterogeneity of data due to there are few MTUs that fully develop it. ConclusionThe ECOEnfSM scale showed very high reliability in MHNP during their training program in Spain. The ECOEnfSM is considered the only objective tool in Spain to assess the professional competencies in this population.

Development and Validation of a Comprehensive Nursing Competence Assessment Questionnaire (CNCAQ) to Determine the Perceived Clinical Competence of Nursing Graduates

Background: An assessment of the clinical competency of nurses at the time of their graduation is essential to get a fair estimate of their level of competence. It helps to lessen the burden on the healthcare system. A “Comprehensive Nursing Competence Assessment Questionnaire (CNCAQ)” has been constructed to fulfil this purpose. Aim: This study aims to develop and validate a CNCAQ to determine the perceived clinical competence of final-year nursing graduates who are about to graduate within three months from selected private and government nursing colleges in India. Methods: A mixed methodology was used and completed in two phases. In phase 1, along with an extensive literature review, focus group discussions, expert evaluation, and pretesting were done, in which 10 nursing experts participated. In phase 2, data were collected from 649 nursing graduates to establish the validity of the construct. The study period was from August to October 2022. Results: The developed CNCAQ has 36 items, comprising four sections: (a) conceptual knowledge and skill in routine nursing care; (b) skill in basic nursing procedures; (c) skill in advanced nursing procedures; and (d) assessment of infusion/transfusion-related nursing procedures. The overall reliability of the tool was 0.963, indicating its high reliability. Overall, there was no difference in clinical competency skills between female and male upcoming nursing graduates. However, statistically significant differences in basic nursing skills and advanced and analytical nursing skills were observed. Conclusions: Assessing nursing students’ competencies is crucial to ensure that they possess the necessary knowledge, skills, and attitudes to provide safe and effective patient care. The development and validation of a valid and reliable instrument for assessing nursing competencies are essential to evaluate nursing students’ clinical performance accurately. In the present research, a tool with a total of 36 items was used. It demonstrates high reliability; however, it needs to be applied to a larger population of nursing graduates with diverse backgrounds. Nurse educators and administrators can use it to assess the level of competence and, accordingly, a tailor-made induction program based on identified weak areas in theoretical and practical knowledge or skill can be developed. No patient’s were involved in the study. It involved developing a CNCAQ and validating it on a selected group of upcoming nursing graduates.

Effect of evidence-based nursing practices training programme on the competency of nurses caring for mechanically ventilated patients: a randomised controlled trial

BackgroundEvidence-Based Practice (EBP) has been recognised worldwide as a standardised approach for enhancing the quality of healthcare and patient outcomes. Nurses play a significant role in integrating EBP, especially in Intensive Care Unit (ICU). Consequently, this study aims to examine the effect of an adapted evidence-based nursing practices training programme on the competency level of nurses caring for mechanically ventilated patients.MethodsA prospective open-label parallel 1:1 randomised controlled trial was conducted on 80 nurses caring for ICU patients at the National Hepatology and Tropical Medicine Research Institute, Egypt. The trial was carried out between November 2022 and February 2023 under the registration number NCT05721664. The enrolled nurses were randomly divided into intervention and control groups. The intervention group received the evidence-based nursing practice training programme (EBNPTP) in accordance with the Johns Hopkins EBP conceptional model, whereas the control group received traditional in-service education. Four assessments (one pre- and three post-assessments) were conducted to evaluate nurses’ competency level over time using the adapted evidence-based nursing competency assessment checklist. The primary endpoint was an increase the competency levels among nurses caring for mechanically ventilated patients.ResultsThe current study results revealed statistically significant differences between intervention and control groups in relation to their level of competency across the three post-assessments, with (p <.001). The study also demonstrated that the nurses’ competency level continued to decline significantly over time, with (p <.001). Additionally, a significant correlation was found between the nurses’ pre-assessment and educational level, acting as independent variables (predictors), and the third endpoint assessment (p <.01), indicated by multiple linear regression.ConclusionThe EBP training programme demonstrated a significant increase in the nurses’ level of competency compared with traditional in-service education. This suggests that by training the nurses in various settings with the essential skills and knowledge for EBP, their competency level can be enhanced, leading to the delivery of effective care and improving patient outcomes. However, the long-term sustainability of the EBP adoptions was insufficient; further studies are needed to investigate the factors that affect the durability of EBP adoption.Trial registrationThe study was registered with Clinical Trials.gov (Registration # NCT05721664) on 10/02/2023.

Comparison of self-competency and executive (charge) nurse competency assessments of clinical nurses.

This study compared nurses' self-competency assessments and their managers' nurse competence assessments. Nurse competence is important for nursing care quality and patient safety. Executive (charge) nurses play a main role in the nurse competency assessment. In this study conducted at a university hospital between January and December 2020, the self-efficacy evaluations of nurses (n=162) working in services other than the emergency department, operating room, and outpatient clinics of the university hospital were compared with the evaluations of nurse executives (charges) on these nurses (n=21). Data were collected using the personal information form and the Nurse Competence Scale. A cross-sectional study design was used. The Strengthening the Reporting of Observational Studies in Epidemiology guideline was used for reporting. Service nurses' self-assessments and nurses treating charge's assessment of clinical nurses evaluated the competence levels as excellent in both groups. The self-competency assessments of the nurses were higher than the charge nurses' competency assessments. In this study, the lower competence assessment of nurses by the charge nurses was may be due to their ability to observe nurses in their teams in general and that they have more experience in evaluation. It is suggested that professional development and competence programs be created to further develop the competencies of nurses. Nurse competency assessments support planning to ensure patient safety. Patient care burden and planning of risky patients according to the nurse competency level will provide safe patient care.

Potential of serious games as a competency assessment tool for acute care nurses on the blood transfusion procedure

Background: Blood transfusion is a life-saving treatment that requires comprehensive knowledge and compliance to safety, administration, and management of blood transfusion process. It is a core competency for a registered nurse. Competency assessments are annually conducted as regulatory requirement and for quality assurance within our institution. Prior to using serious games, competency assessment involved an online learning module followed by a face-to-face assessment. This had limitations such as such as limited opportunities, potential lack of standardisation, time, and resources. Aim: The aim of this study was to assess whether serious game for blood transfusion administration could be a valid and reliable nursing competency assessment tool through capturing and analysis of in-game empirical data. Methods: The nursing department from Singapore General Hospital (SGH) developed a serious game for blood transfusion administration. The game modules were developed to match the actual procedure with established learning objectives at each stage. The game’s content validity was assessed by four external subject-matter-experts. Gameplay data of 1093 nurses were tested for construct validity, internal-consistency reliability, and criterion validity of the game. Results: The item-level content validity index (I-CVI) ranged between 0.75 and 1, while the average of the I-CVI scores for all items on the scale (S-CVI/Ave) was 0.99. Six factors and 82 game actions were obtained using principle factor analysis. Most game actions had a communality value (h2) above 0.5. The Inter-factor correlations between the six factors ranged from 0.2 to 0.45. Internal-consistency reliability estimates (α) (together with their 95% CIs) for the stages were greater than 0.75, with an overall of 0.96 for the 82 game actions. Linear association between each predictor and the criterion were below 0.25. Conclusion: Based on the empirical data collated, we conclude that the serious game may be a valid competency assessment tool for nurses in SGH. For future work, we propose to conduct the blood transfusion serious game in other hospitals to further support its validity and reliability as a competency tool for multi-step complex procedural clinical skills.

Developing the better and effective nursing education for improving transcultural nursing skills cultural competence and cultural sensitivity assessment tool (BENEFITS-CCCSAT)

BackgroundA clear need for the development of new comprehensive, reliable, sensitive and valid measurement tools to adequately asses the cultural competence and cultural sensitivity of nursing students exists. This study aimed to develop a new measurement tool to assess the nursing students’ cultural competence and sensitivity.MethodsThis cross-sectional, instrument development study’s first phase included postgraduate nursing students (n = 60) for the piloting study, and the second one included undergraduate nursing students (n = 459) for the main survey. This study used two data collection forms: The Student Descriptive Information Form and the Better and Effective Nursing Education for Improving Transcultural Nursing Skills Cultural Competence and Cultural Sensitivity Assessment Tool (BENEFITS-CCCSAT) draft. The content validity index was calculated using the Davis method. Cronbach’s α coefficient and the item total correlation were calculated during the reliability analysis. The Kaiser-Meyer-Olkin (KMO) coefficient test, Bartlett significance test, and explanatory factor analysis (EFA) were used to evaluate the validity of the assessment tool.ResultsScale validity and reliability analyses showed that the BENEFITS-CCCSAT included 26 items and five sub-dimensions: respect for cultural diversity; culturally sensitive communication; achieving cultural competence; challenges and barriers in providing culturally competent care; and perceived meaning of cultural care.ConclusionThe BENEFITS-CCCSAT appears to be a valid and reliable instrument for measuring the cultural sensitivity and cultural competence of nursing students. This can be of great use, especially before attending clinical areas, and can offer both students and faculty reliable information to promote reflective and critical thinking, especially in areas where improvement is needed.

Can Simulation Scenarios Be Designed to Assess Ongoing Nursing Competence?

Learner-centered verification methods are at the core of Donna Wright's model for competency assessment. Using Wright's framework, an academic medical center studied the use of simulation as a verification method for their annual ongoing nursing competency assessment. Of the 10 pilot participants, 60% used simulation as a verification method to successfully show competence. Assuming adequate professional development practitioner and facility resources, simulation can be used as an option for ongoing competency assessment.

Validation of the Advanced Practice Nursing Competency Assessment Instrument in a hospital environment.

to evaluate the measurement properties of the Advanced Practice Nursing Competency Assessment Instrument - Brazilian version, in the hospital environment. a methodological study conducted in a hospital with 238 nurses. Three instruments collect the data: sample characterization form, Brazilian version of the Advanced Practice Nursing Competency Assessment Instrument, and the category "therapeutic interventions" of the nurse competence scale. Construct validity was verified by confirmatory factor analysis and Spearman's correlation coefficient, and reliability by Cronbach's Alpha and composite reliability. in the factor analysis, the model converged to a satisfactory result. The study found acceptable evidence of reliability (Cronbach's Alpha, 0.76-0.87; and composite reliability, 0.85-0.90). the instrument demonstrated evidence of construct validity and internal consistency and can be used in practice.

Validation of the Advanced Practice Nursing Competency Assessment Instrument in a hospital environment

RESUMO Objetivos: avaliar as propriedades de medida do Instrumento para Avaliação de Competências do Enfermeiro de Prática Avançada – versão brasileira, no ambiente hospitalar. Métodos: estudo metodológico, realizado em um hospital, com 238 enfermeiros. Os dados foram coletados por meio de três instrumentos: ficha para caracterização da amostra; versão brasileira do Instrumento para Avaliação de Competências do Enfermeiro de Prática Avançada; e a categoria “Intervenções Terapêuticas” da Escala de Competência do Enfermeiro. A validade de construto foi verificada por meio da análise fatorial confirmatória e do coeficiente de correlação de Spearman; e a confiabilidade, por meio do alfa de Cronbach e da confiabilidade composta. Resultados: na análise fatorial, o modelo convergiu para um resultado satisfatório. Foram encontradas evidências satisfatórias de confiabilidade (alfa de Cronbach, 0,76-0,87; e confiabilidade composta, 0,85-0,90). Conclusões: o instrumento demonstrou evidências de validade de construto e consistência interna e poderá ser utilizado na prática.

Development of Nursing Informatics Competence Scale for Korean Clinical Nurses.

Much of the research on nursing informatics competence has been conducted in a Western context. Thus, this study aimed to develop the Korean Nursing Informatics Competence Assessment Scale for clinical nurses and to evaluate its validity and reliability. A total of 52 items were derived based on the hybrid model. After a content validity test by six experts and item evaluation by 20 nurses, the scale was revised to include 35 items. For this study, 214 nurses completed the nursing informatics competence assessment scale to verify the scale's reliability and validity. Confirmatory factor analysis revealed five factors composed of 20 items; the fit index of the derived model was good. A positive correlation between scores on the nursing informatics competence scale and the patient safety competence scale ( r = .66, P < .001) was found for the criterion-related validity test. Cronbach's α was .91, indicating that the instrument is reliable and stable. Overall, this study provides preliminary evidence for the validity and reliability of the Korean nursing informatics competence assessment scale to evaluate clinical nurses. This study contributes to the understanding and improvement of nursing informatics competence by providing a reliable scale for assessing clinical nursing practice.

Competency assessment for community health nurses: a focus group expert panel discussion

BackgroundGeneral Practice setting in the Primary Health Care Services are the utmost visited by the public. It is important that the nurses’ competencies in this area be assessed to ensure provision of safe and quality services.Aim/objectiveTo explore perceptions and experiences of competencies assessment tool for community health nurses working at the General Practice setting in the Primary Health Care Services.MethodsAn exploratory qualitative study utilizing focus group discussions were conducted on purposive sample of 12 officers with expertise in competency assessment and community health nursing from higher nursing education institutions, the Nursing Training and Development Centre, the Nursing Board and the Community Health Nursing Services in Brunei Darussalam. The existing competencies assessment tool was revised, the participants were divided into two groups of expert panel review team and two focus group discussions were held with each team. The focus group discussions encompassed components and methods of assessment; methods of grading; and overall organization and structure of the revised competency assessment tool.FindingsFour themes emerged: 1) International equivalent core competencies components; 2) Multi-methods approach to assessment; 3) Definitive guidelines as framework for assessment; and 4) Understanding and acceptability of the competency assessment tool.Conclusions/implications to practiceThe expert panel reviews provide practical input that were inculcated in the preliminary developed competencies assessment tool. Identification of eligible assessors were recommended based on standardized criteria, and socialization and training held to set direction and guidance for implementing the utilization of the competencies assessment tool. Further studies are deemed important to critically evaluate and validate the preliminary competencies assessment tool for development of a more robust assessment instrument.

Psychometric evaluation of a nursing competence assessment tool among nursing students: a development and validation study

BackgroundNursing competence refers to the core abilities that are required for fulfilling one’s role as a nurse. A specific instrument comprehensively measuring competence among nursing students has not yet been developed. The purpose of the study was to develop and validate a nursing competence instrument for nursing students in bachelor training.MethodsA descriptive and explorative study design was used. Data were collected from students at one medical college in Taiwan in 2020 and 2021. A total of 241 nursing students participated in this study. We developed the initial instrument through systematic review, expert evaluations, and pilot versions. Its validity was then tested using confirmatory factor analysis (CFA) and criterion-related validity, while its reliability was tested using Cronbach’s alpha and test–retest analysis.ResultsThe final fit indexes of CFA were as follows: chi-square = 860.1 (p < 0.01), normed chi-square = 2.24, SRMR = 0.04, RMSEA = 0.07, CFI = 0.94, and TLI = 0.94. Cronbach’s alpha values for the subscales observed ranged from 0.91 to 0.98. The test–retest reliability coefficient for the Nurse Competence Scale was 0.515 (n = 30, p < 0.01).ConclusionsThe instrument exhibited acceptable psychometric properties, thereby proving itself a valuable tool for evaluating nursing students’ competence at bachelor training. Further assessments of its reliability, validity, and generality from mentors’ and scholars’ views in different contexts and cultures are recommended.

The Clinical Nursing Competency Assessment System of Ghana: Perspectives of Key Informants

It is essential to ensure that nurses are well trained and competent enough to provide safe and quality healthcare because of the critical role they play in the health systems globally. It is against this backdrop that Ghana instituted nursing licensing examination which includes clinical competency assessment. This qualitative exploratory descriptive study sought to explore and describe the perspectives of key informants on the clinical nursing competency assessment in Ghana. A total of 20 purposively selected key informants (nurse educators, nurse clinicians, and nurse managers) were interviewed. Data was analyzed using thematic content analysis. Although the intention of the clinical competency examination conducted by the nursing council is to ensure that only competent nurses are licensed to practice in Ghana, there are inherent issues such as manipulation of examiners, poor training of examiners, unstandardized assessment process, and inadequate resource which compromises the intent of the process. The nursing council admitted to not being aware of some of the challenges found in this study and will work towards improving the quality, validity, reliability, and fairness of the examination system. It is essential that the council institute quality improvement processes, including independent research into the examination process, to continually improve on the process because other countries within the sub-region try to benchmark their nursing licensing examination on that of Ghana.

Psychometric properties of clinical competency assessment instruments for psychiatric nurses: A systematic review of literature.

Facilitating the healing process of patients with psychiatric disorders depends on high-quality mental health care and expert psychiatric nurses. A valid tool is required to objectively evaluate the quality of performance and competency of psychiatric nurses. This systematic review aimed to investigate and critique the psychometric properties of some psychiatric nursing clinical competency assessment instruments with Consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist and according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). To retrieve published articles using Persian and English keywords "psychiatric nursing," "competence," "competency," "tool," "checklist," "scale," "questionnaire," "psychiatric mental health nurse," were searched in databases without time limitation. Then, psychometric properties of selected instruments were evaluated using the COSMIN checklist and reported according to the PRISMA statement. Most of these tools did not entirely and desirably report psychometric properties. It is not designed as a special tool for postgraduate psychiatric nursing. The methodology of existing instruments does not meet the COSMIN checklist criteria; therefore it needs to develop. To assess the competency of psychiatric nursing postgraduate, a tool tailored to the cultural and social context and with acceptable psychometric properties is necessary.

Adaptation and validation of the Advanced Practice Nursing Competency Assessment Instrument.

To adapt and validate the content of the Advanced Practice Nursing Competency Assessment Instrument (APNCAI) to Brazilian culture. This is a methodological study that followed the stages of translation, synthesis, back translation, evaluation by a committee of five specialists, pre-test with 31 nurses, and evaluation by the author of the original instrument. The Content Validity Index (minimum 0.90) and the modified Kappa (minimum 0.74) were calculated to evaluate the content. In the first round of content evaluation, 18 items had to be altered because they did not reach the minimum values established. Three items have not reached a consensus in the second round and had to be sent to the author of the original version. In the pre-test, 13 items were returned to the specialists because they suffered content changes. The Advanced Practice Nursing Competency Assessment Instrument (APNCAI) - Brazilian version was cross-culturally adapted, and its content was validated.

Clinical nursing competency assessment: a scoping review

Abstract Objective To ensure that only competent graduates are licensed to practice nursing, councils conduct licensing examinations, which may include among others clinical competency assessment. This review explored current practices in clinical competency assessment of nursing students as part of a larger study aimed at developing an evidence-based, context-specific framework for clinical competency assessment in a sub-Saharan African (SSA) country. Methods A scoping guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was conducted. Results Findings from 28 out of 1151 studies identified from Scopus, PubMed, CINAHL, Wiley Online Library, and ProQuest were included and synthesized. Results show that a good assessment system must be valid, reliable, transparent, feasible, fair, objective, and must provide feedback and continually improve to have an educational impact. Clinical competency assessment systems must be developed on sound empirical evidence, pilot tested, and involve thorough training and evaluation of the examiners. Continuous evaluation of the assessment system is also essential to ensure the quality and relevance of the assessment system. Only one of the included studies was conducted in Africa. Conclusions The paucity of clinical competency assessment research in sub-Saharan Africa may lead to benchmarking assessment systems on research conducted outside the context. Sub-Saharan Africa has a set of circumstances that demand a context-specific clinical competency assessment framework to guide clinical competency assessment.

Improvement of Nursing Self-Efficacy for Labor Support Techniques and Implementation of the Coping With Labor Algorithm

There is a 15-fold variation in cesarean birth rates across the United States, yet only 25% can be explained by health risks or objective diagnoses.1,2 This suggests that care practices in hospitals may influence cesarean birth rates. The implementation of care bundles is intended to reduce practice variations. The Promoting Comfort in Labor bundle from the American College of Nurse-Midwives’ Reducing Primary Cesarean Collaborative (RPC) was adopted by our hospital in south central Virginia. Bundle items include provision of continuous labor support ( CLS ), availability of nonpharmacologic tools for comfort, assessment of coping instead of pain, and initial and ongoing education for nurses on nonpharmacologic comfort methods. We used the Nurses’ Care of Women in Labor Survey to guide and evaluate effectiveness of policy changes and education for nurses and implemented the Coping With Labor Algorithm as the unit’s pain-assessment tool. We sent the nursing staff an e-mail and administered the survey using an online survey tool in 2016, 2017, and 2019. All employed labor and delivery nurses were invited to voluntarily participate. The rate of patients receiving CLS and assessment for coping was tracked on a monthly basis. The work was Institutional Review Board–exempt as quality improvement related to participation in the RPC Collaborative. From 2016 to 2019, nursing knowledge of the benefits CLS and confidence in the ability to use CLS techniques increased (p = 1.81E-09, and p = .00000, respectively). From baseline in 2015 to 2019, the rate of patients receiving CLS increased from 3.93% to 4.87% (p = .307). The rate of pain assessment as coping–not coping increased from 44.5% before formal implementation to 79.6% (p = .0000021) after 18 months. Survey-guided education resulted in increased knowledge of outcomes associated with labor support as well as self-efficacy for skill and comfort using labor support techniques. More women received CLS. Use of coping–not coping as the tool to assess labor pain increased. Areas to improve included provider education, better collaboration with doulas, and establishing a program for annual competency assessment for nurses. Additional changes to documentation fields in the health record are needed to make it simpler to consistently document CLS and coping for improved data tracking and improvement.

Diagonal Interventions in Infection Prevention: Successful Collaboratives to Decrease CLABSI at a VA Health Care System

Background: Vertical interventions in public health are disease focused, whereas horizontal interventions are systems based. The new concept of “diagonal interventions” merging these 2 approaches is also applicable to infection prevention (IP). During fiscal year (FY) 2016, our facility identified 14 central-line–associated blood stream infections (CLABSIs), resulting in a rate of 1.44 cases per 1,000 catheter days, twice that of FY2015 (0.75 cases per 1,000 catheter days). Methods: Focusing on a horizontal “systems building” approach, the IP team used previously developed informal relationships to mobilize a formal multidisciplinary team comprised of IP, nursing educators, the intravenous therapy team, and frontline staff. Initially charged with implementation of disinfecting caps for needleless connectors, the IP team capitalized on this multidisciplinary resource to launch a multifaceted communication and education campaign supporting CLABSI-specific interventions. For vertical interventions, an IP risk assessment revealed variations in care and maintenance of central lines and the need for staff education. A literature search was conducted to identify evidence-based strategies for reducing CLABSIs, leading to the development of a nursing-led bundle of the following elements: (1) education on CDC hand hygiene guidelines, (2) central-line competency validation and assessment for nurses on hire and annually, (3) standardized processes across all wards for central-line dressing changes (“timed on Tuesdays”), and (4) a pilot program for disinfecting caps on 3 inpatient wards. The IP team identified CLABSIs using standard NHSN definitions. Catheter days were obtained on each inpatient ward. Unit-specific rates were calculated per 1,000 catheter days. Mann-Kendall Test was used to assess rate trends over time, whereas the Fisher exact test was used for rate comparisons. A P &lt; .05 was considered significant. Results: CLABSI rates decreased from 1.44 in FY2016 to 0.12 in FY2019 (Kendall τ = −0.5; P &lt; .001) (Fig. 1). During the 3-month pilot phase of disinfecting caps, no CLABSIs were identified on 3 intervention wards versus 3 CLABSIs on control wards (rate, 0 vs 2.57; P = .27) and 1 CLABSI in the 3-month baseline period prior to the intervention (0 vs 0.40; P &gt; .99). Disinfecting caps were expanded house-wide beginning in FY2018. The multidisciplinary team evolved into a sustained collaborative (“Scrub Club”) meeting biweekly. They have now broadened their focus to quality improvement initiatives for multiple healthcare-associated infections (HAIs). Conclusions: The IP team has traditionally utilized vertical models of intervention. The use of “diagonal” models that incorporate horizontal health systems strengthening can transform multidisciplinary partnerships into long-term collaboratives essential for sustained reduction of HAIs.Funding: NoneDisclosures: None