Perception Of Clinical Competence Research Articles

The impact of comprehensive licensure review on nursing students’ clinical competence, self-efficacy, and work readiness

This study aims to assess the effectiveness of comprehensive licensure reviews and adaptive quizzing assignments on nursing students' clinical competence, self-efficacy, and work readiness—an under-researched topic. Additionally, it seeks to explore the mediating effect of self-efficacy in the relationship between students’ clinical competence and work readiness. A quasi-experimental (pre- and post-test), single-group design was employed. The study was conducted in a public university in Saudi Arabia and included a total of 293 senior nursing students in their last year of the bachelor program. An intervention was developed based on the blueprints of the Saudi Nursing Licensing Exam and NCLEX-RN and consisted of a weekly 3-h synchronous comprehensive licensure review bundled with 23 adaptive quizzing assignments over 15 weeks. Data were collected prior to and after the intervention using three scales: clinical competence, self-efficacy, and work readiness. The mean scores of clinical competence, self-efficacy, and two subscales of work readiness (work competence and social intelligence) increased significantly post-intervention.Self-efficacy (β = 0.353, p < 0.001) and clinical competence (β = 0.251, p < 0.001) influenced work readiness (F [5, 226] = 21.03, p < 0.001) and accounted for 31.8% of the explained variability in work readiness. In the mediation analysis, clinical competence had a significant and indirect effect on work readiness through self-efficacy (B = 0.464, p < 0.001, 95% CI 0.250 to 0.699). The proportion of mediation indicated that 37.2% of the total effect of clinical competence on work readiness was due to the indirect effect of self-efficacy. Comprehensive licensure review and adaptive quizzing assignments improve students’ perceptions of clinical competence and self-efficacy. Such interventions could ease the transition of senior nursing students to clinical practice.

Competencies Associated With Australian and New Zealand Podiatrists’ Perceptions of Their Preparedness for Graduate Clinical Practice

Podiatry training institutions are responsible for preparing future podiatrists to be competent and safe practitioners. This follow-up study investigated podiatrists’ self-reported preparedness to practice through their ratings of various competencies. An online retrospective survey comprising closed and open-ended questions was distributed to registered and practising podiatrists in Australia and New Zealand. Of the 74 podiatrists who completed the survey, 75.7% felt “prepared” for clinical practice at graduation, with preparedness univariately associated with being female (p = .042), overall perception of clinical competence (p = .004), preparedness for clinical placement as a student (p &lt; .001), theoretical knowledge (p &lt; .001), manual skills (p = .002), and clinical competence standards (p &lt; .001). Multivariable analysis identified preparedness for student clinical placement (OR = 8.95, 95%CI 1.92 – 41.76) and overall theoretical knowledge (OR = 19.29, 95%CI 3.76 – 99.13) being significantly associated with perceived preparedness for practice. Age, qualification, and graduation year were not associated with perceived preparedness. Positive clinical placement experiences enhanced their perceived preparedness, while limited clinical exposure hindered preparedness, potentially resulting in a probable theory-practice gap, and lowered professional self-efficacy. While generally feeling prepared to practice as podiatrists at graduation, they identified the need for additional hands-on learning with early patient exposure in diverse settings during their training, which should improve self-efficacy.

A Multisite Assessment of Saudi Bachelor Nursing Students' Perceptions of Clinical Competence and Learning Environments: A Multivariate Conceptual Model Testing.

Background: It is thought that students' perceptions of educational and clinical learning environments improve the effectiveness of curricula and professional standards. It is essential to examine the educational and clinical learning environments in which nursing students learn, as well as how nursing students evaluate particular factors of these environments. Objectives: The objectives of this study were to (1) identify nursing students' perceptions on professional competence and learning environments in the classroom and clinical settings and (2) test a hypothetical model of variables that influence and predict students' perceptions of learning environments and professional competencies. Methods: The study employed a descriptive cross-sectional methodological design. Five hundred and eighteen undergraduate nursing students were recruited from three Saudi Arabian universities using a convenient sampling technique. Using valid and reliable self-reported questionnaires, including the Dundee Ready Educational Environment Measure (DREEM), the modified Clinical Learning Environment Inventory (CLEI), and the Nurse Professional Competence Scale-Short (NPCS-SF), data were collected. Results: Perceptions of professional competence and learning environments were positive among nursing students. With satisfactory fit indices, the final model found that students' perceptions of clinical competence were significantly predicted by their perceptions of the clinical environment (B = 0.43, p &lt; 0.001), students' perceptions of university environments (B = 0.29, p &lt; 0.001), ward type (B = 0.12, p &lt; 0.001), and students' year of study (B = 0.11, p &lt; 0.001). The students' perceptions of clinical environments were significantly predicted by their perceptions of the university environment (B = 0.31, p &lt; 0.001), gender (B = 0.13, p &lt; 0.001), students' year of study (B = 0.12, p &lt; 0.001), and ward type (B = 0.11, p &lt; 0.001). Moreover, the students' perceptions of the university environment were significantly predicted by gender (B = 0.11, p &lt; 0.001) and length of training (B = 0.12, p &lt; 0.001). Conclusions: A range of factors might influence students' perceptions of their professional competence and learning environments. Improving the learning environments and clinical experiences of students could enhance their clinical competence. This study's findings provide evidence for how to enhance the learning environments in the classroom and clinical settings in order to improve students' clinical competence, which will ultimately result in better patient outcomes. It is a top priority for nursing educators all around the world to improve classroom and clinical learning settings that foster students' learning and professional competencies.

Gender Bias in Risk Management Reports Involving Physicians in Training – A Retrospective Qualitative Study

Gender bias, which contributes to burnout and attrition of female medical trainees, may manifest as disparate workplace evaluations. Here, we explore gender-based differences in perceived competence and professionalism as described in an institutional electronic risk management reporting system. In this retrospective qualitative study, recurring themes were identified from anonymous entries reported to an electronic institutional risk management database from July 2014 to July 2015, and from July 2019 to July 2020 using inductive methods. This electronic system is often used by hospital staff to document complaints against physicians under the pretext of poor patient care, regardless of whether an adverse event occurred. Two individuals independently coded entries. Themes were determined from event indicator codes (EIC) using Delphi methodology and compared between gender and specialty using bivariate statistics. A multi-center integrated healthcare delivery system. Risk management entries pertaining to physician trainees by hospital staff as written submissions to the institution's electronic risk management reporting system. Main outcomes included themes defined as: (1) lack of professionalism (i.e., delay in response, attitude, lack of communication), (2) perceived medical error, (3) breach of institutional protocol. Of the 207 entries included for analysis, 52 entries identified men (25%) and 31 entries identified women (15%). The gender was not available in 124 entries and, therefore, categorized as ambiguous. The most common complaint about men involved a physician-related EIC (n = 12, 23%, EIC TX39) and the most common complaint about women involved a communication-related EIC (n = 7, 23%, EIC TX55). Eighty-eight (43%) entries involved medical trainees; 82 (40%) involved surgical trainees. Women were more often identified by their name only (n = 8, 26% vs. n = 3, 6%; p < 0.001). This finding was consistent in both medical (n = 0, 0% vs. n = 5, 31%; p < 0.001) and surgical (n = 2, 7% vs. n = 3, 25%; p = 0.006) specialties. In entries involving women, a lack of professionalism was most frequently cited (n = 29, 94%). Entries identifying medical errors more frequently involved men (n = 25, 48% vs. n = 7, 23%; p = 0.02). Gender-based differences exist in how hospital staff interpret trainees' actions and attitudes. These differences have consequences for training paradigms, perceptions of clinical competence, physician burnout, and ultimately, patient outcomes.

Professional nurses' perceptions regarding clinical competence of community service nurses in North West province, South Africa.

BackgroundSouth African Nursing Council requires nurses who successfully complete their training to perform a year of community service before obtaining registration as professional nurses (Regulation 425). Community service for health professionals was introduced as a strategy to retain newly qualified professionals within the country. The premise is that community service for newly graduated nurses gives them the opportunity to develop skills and acquire knowledge critical in their professional development.AimTo explore and describe the perceptions of professional nurses as the supervisors of community service nurses (CSNs) during their 12 months of community service.SettingSelected hospitals of the North West province, South Africa.MethodsA qualitative, exploratory and descriptive design was used. The study was conducted between September and November 2018 at three public hospitals in the North West province. Through purposive sampling, 15 professional nurses who supervise CSNs participated in the study. Data were collected in three focus group discussions using semi-structured questions. All focus group discussions were recorded and transcribed for analysis. Data were analysed using Pienaar’s four steps of thematic analysis.ResultsThree themes emerged: perceptions of clinical competence, challenges impacting clinical competence and suggestions to improve clinical competence.ConclusionIt is suggested that even though the majority of CSNs were perceived to be competent and capable of working independently, they still required supervision and mentorship to refine their competency. Furthermore, the study reported similar challenges noted from previous studies that were perceived to be affecting CSNs’ ability to deliver quality health care, and therefore recommendations for improvement were made.ContributionThe study contributed to the developed the clinical competence evaluation tool which will be of benefit to the future community service nurses in the province.

Student and Faculty Perceptions of Clinical Competence During Problem-Based Learning

Abstract Date Presented 03/28/20 This research will help provide evidence for the current debate related to the doctoral mandate by comparing doctor of OT students’ and master of OT students’ levels of clinical competence based on faculty assessment and student self-perceptions during the completion of problem-based learning modules. Primary Author and Speaker: Nicole Farbaniec Additional Authors and Speakers: Gabrielle Hackenberg Contributing Authors: Jessica Vitale

Nursing interns' perception of clinical competence upon completion of preceptorship experience in Saudi Arabia

BackgroundNursing interns are newly graduate students with limited real-life work experiences. These novices are in the process of enhancing their competencies in the delivery of quality nursing care with the guidance of the preceptors. Hence, it is relevant to examine the impact of preceptorship, as a teaching strategy, among nursing interns during their preceptorship years in clinical settings. ObjectiveThe aim of this study is to determine if the preceptorship program has provided the nursing interns the needed education in enhancing clinical competence. SettingThe study was conducted in one of the tertiary hospitals in Riyadh, Saudi Arabia. ParticipantsConvenience sampling was used to recruit 92 undergraduate nursing interns who have completed the five-years nursing education including preceptorship. MethodsThe nursing interns completely answered the survey questionnaires which covers Benner's Competencies, Knowles' Adult Learning Theory and the Nursing Process. DesignThe study followed a mixed-methods design wherein a descriptive cross-sectional approach was used to identify factors affecting the nursing interns' perception towards clinical competence. Two open-ended questions referring to the improvement of internship program and competency were concurrently collected which was the qualitative portion of the study. ResultsThe preceptorship program enhanced the preceptees competencies in the clinical setting primarily in priority-setting with acutely ill patients, multitasking and demonstrating complex nursing skills. The majority of the nursing interns perceived preceptorship as a constructive experience. The availability, approachable attitude, and trustworthiness of the preceptor were viewed as influential factors in improving the interns' clinical competence. Variations were significant with phases of internship and type of school. Furthermore, results showed positive correlation between the nursing interns' efficacy and clinical competencies in professional behavior, general performance, and core nursing skills. ConclusionPreceptorship program positively impacts nursing interns' skills in handling actual patients in clinical setting. Hence, the preceptorship program is an effective teaching strategy which advances the novice to the next stage of developing clinical competence.

Examining Doctor of Nursing Practice Clinical Competency

Abstract An assessment of post-master's Doctor of Nurse Practice (DNP) education on clinical practice outcomes for master's-prepared advanced practice registered nurses (APRNs) may inform DNP program development and practice. Electronic survey assessment of DNP-APRN perceptions of clinical competency after completion of post-master's DNP education indicated engagement in DNP Essentials. Overall, DNP-APRNs report consistently engaging in competencies associated with Essentials I, II, III, VI, VII, and VIII, and to a lesser extent, competencies for Essential IV. These findings indicate DNP-APRNs function as change agents, patient advocates, and proponents of improved patient and community outcomes. Comparisons before and after DNP-APRN education are indicated for assessment of practice and program development.

Women's views and experience of their maternity care at a referral hospital in Ghana

Reducing death and morbidity by promoting high quality maternal and newborn care is a key goal for global health programmes. A recent systematic review defined quality care as preventive and supportive care with effective treatment for problems when they arise ( Renfrew et al, 2014 ). It showed that women want health professionals who combine clinical skills with interpersonal competence. This article describes a qualitative study to explore the experiences of eleven newly delivered women at a large referral hospital in Accra, to identify which factors contributed to a positive or negative birth experience. The study found that women's satisfaction or dissatisfaction were due to their perceptions of clinical competency (basic, practical, timely monitoring and treatment) and emotional support (respect, kindness and reassurance).

Impact of Military Physician Rank and Appearance on Patient Perceptions of Clinical Competency in a Primary Care Setting

The patient-physician interaction is an important aspect of primary care medicine. Few studies have investigated the military specific factors that influence these interactions. Using a cross-sectional survey, we evaluated the impact of physician rank and attire on a patient's confidence in their physician's medical abilities and willingness to disclose personal information. Patient perception was assessed in the domains of (1) confidence in physician's medical abilities and (2) comfort discussing sexual, psychological, and personal problems with a physician. Our results found physicians of higher rank showing a higher positive impact on patient's confidence compared to lower ranks (p < 0.0001). Patients were less comfortable discussing sexual (p = 0.001), psychological (p < 0.0001), and personal (p = 0.005) problems with an O-3 (Air Force Captain) than higher ranked physicians. Casual business attire negatively affected patient's confidence in their physician's abilities and in their comfort discussing sexual, psychological, and personal problems (p < 0.0001). Removing resident physician data did not significantly alter results. This pilot study on military rank and appearance shows a statistically significant impact to patient-physician interactions. Lower rank and casual attire is statistically detrimental to the patient's perception of their physician's abilities irrespective of resident physician involvement.

The view from over there: reframing the OSCE through the experience of standardised patient raters

Ratings awarded by standardised patients (SPs) in UK objective structured clinical examinations (OSCEs) are typically based on humanistic (non-technical) skills and are complementary to clinician-examiner ratings. In psychometric terms, SP ratings appear to differ from examiner ratings and improve reliability. For the first time, we used qualitative methods from a constructivist perspective to explore SP experiences of rating, and consider how these impact our understanding of assessment. We used constructivist grounded theory to analyse data from focus groups and individual semi-structured interviews with 38 SPs and four examiners. Inductive coding, theoretical sampling and constant comparison continued until theoretical saturation was achieved. Standardised patients assessed students on the core process of relationship building. Three theoretical categories informed this process. The SP identity was strongly vocational and was both enacted and reinforced through rating as SPs exerted their agency to protect future patients by promoting student learning. Expectations of performance drew on individual life experiences in formulating expectations of doctors against which students were measured, and the patient experience was a lens through which all interactions were refracted. Standardised patients experienced the examination as real rather than simulated. They rated holistically, prioritised individuality and person-centredness, and included technical skill because the perception of clinical competence was an inextricable part of the patient experience. The results can be used to reframe understanding of the SP role and of the psychometric discourse of assessment. Ratings awarded by SPs are socially constructed and reveal the complexity of the OSCE process and the unfeasibility of absolute objectivity or standardisation. Standardised patients valued individuality, subjective experience and assessment for learning. The potential of SPs is under-used their greater involvement should be used to promote real partnership as educators move into a post-psychometric era. New-generation assessments should strive to value subjective experience as well as psychometric data in order to utilise the significant potential for learning within assessment.

Perceptions of clinical competence among nurse pregraduates: Do different types of nursing programs make a difference?

Background: New graduate nurses’ competence rarely meets the rigorous expectations of clinical settings. Researchers suggest that competency validation before graduation can shorten the length of clinical orientations for graduate nurses after they enter the workforce. The purpose of this study was to explore the difference in clinical competence between students in different types of nursing programs and to identify skills that need to be reinforced. Methods: This longitudinal study included 461 students from three different nursing programs: a four-year regular nursing program and a two-year RN-BSN program in day school and night school. A total of 478 students were invited to participate, and 440 students completed and returned questionnaires either at one year before or at the time of graduation with a total response rate of 92.05%. Results: At the time of graduation, students in all three nursing programs perceived low competence in overall clinical skills. Students in a two-year RN-BSN night school perceived significantly lower competence than students in two other types of nursing programs. Nurse students’ general performance skills and advanced nursing skills need to be reinforced before graduation. Conclusions: More opportunities for students’ involvement in case-based studies to cultivate their ability to integrate their knowledge and skills and more accumulated hours in deliberate practice with external sources such as electronic resources, training facilities and skill consultation on performance are recommended to enhance students’ clinical competence.

The effects of a deliberate practice program on nursing students' perception of clinical competence

New nursing graduates' readiness for practice often does not meet the requirements needed in the real situation of clinical sites. Therefore, nurse education has placed more emphasis on developing students' technical skills to cultivate proficiencies needed for clinical sites. To develop a program including deliberate skill practices and technical skill testing, each conducted before students' clinical practicum, and to examine the program's effects on nursing students' clinical competence. The study was a repeated measure correlational design. One nursing university. Two-hundred-fifty-six and 266 nursing students in a RN-to-BSN night school program in Taiwan completed pretest and posttest surveys, respectively in 2009 and 2010. Their mean age was 22.61 years and had worked 12.75 months as a nurse. Students were asked to participate in the deliberate nursing practice program, which includes skill practice and tests, before their last clinical practicum. The Clinical Competence Questionnaire was used to measure the outcome of deliberate practice. Findings indicated that participants who had nursing work experience, a higher grade point average, practiced their skills by watching videos, and higher pretest competence scores exhibited significantly higher posttest competence scores. Participants who worked in the operating room/outpatient department, scored higher on self-confidence in clinical performance, and had a higher level of future job stress exhibited significantly lower posttest competence scores. Although work experience increased clinical competence, working in the operating room/outpatient department where many nursing skills were not performed did not have the effects. In contrast, skill reviews and better performance before practice promoted competence. Attaining motor skill competency is a slow process requiring practices. Thus, providing deliberate skill-practice program is suggested to help students increase their competence.

Traditional Clinical Versus Simulation in 1st Semester Clinical Students: Students Perceptions After a 2nd Semester Clinical Rotation

BackgroundTraditional clinical experiences are being supplemented with high-fidelity simulation (HFS) in many nursing programs. The immediate and long-term impact on students' perception of clinical competence is not known. MethodSurveys were administered to 1st-year nursing students following their first-semester clinical experiences in either a traditional or an HFS setting. Differences between the two groups were compared by analysis of the results of a survey of perceived clinical competence. The comparison was made again for the cohorts following their second-semester hospital-based clinical experiences. ResultsSignificantly higher scores were reported by the HFS group initially, but this difference was less pronounced following second-semester hospital-based clinical experiences. ConclusionsStudents with first-semester HFS experiences had initial higher perceptions of competence. Further research is needed to demonstrate the short- and long-term impact of simulated experiences on perceived competence, as well as on clinical performance.

Relationships of New Nurses' Perceptions and Measured Performance-Based Clinical Competence

This study examined the relationship between new nurses' performance-based measurements and perceptions of clinical competence. Descriptive correlational designs were used to examine the relationships. Performance-based clinical competence was measured by the Performance Based Development System developed by Del Bueno (1990), and perceived competence was measured by specific items on the Casey-Fink Graduate Nurse Experience Survey (1999). Findings showed a significant difference in mean patient scores and professional role scores. Nurses who met the criteria for problem management had significantly higher scores on the patient care scale and the professional role scale than those who did not meet the criteria. Nurses with previous work experience (44%) were more likely to meet the criteria for problem management. Black participants scored lower on the patient care scale compared with others. This study provides a beginning understanding of the relationship between new nurses' perceptions and performance-based clinical competence.

The effect of clinical targets on productivity and perceptions of clinical competency: Stacey MA, Morgan MA, Wright C. J Dent Educ 62:409, 1998

The effect of clinical targets on productivity and perceptions of clinical competency: Stacey MA, Morgan MA, Wright C. J Dent Educ 62:409, 1998

The effect of clinical targets on productivity and perceptions of clinical competency

This study investigated the effect of clinical targets on clinical productivity and perceptions of clinical competency of final-year undergraduate dental students. Students were randomly divided into two equal groups. One group was set annual numerical clinical targets while the other had no targets. All final-year students and final-year clinical teachers were asked to complete a questionnaire rating six different aspects of student clinical competency at the end of semester 1 and semester 2. Changes in perception of clinical competency by students and clinical teachers were compared between the target and no-target groups and between students and clinical teachers. The clinical output of both groups was measured. There was no significant difference in performance between the target and no-target group as assessed by clinical teacher or by student self-assessment. However, by the completion of the study the clinical teachers scored the students (irrespective of group) significantly lower for clinical competency than students assessed themselves. There was no significant difference between the productivity of the two groups. The setting of clinical targets had no measurable effect on the perceived clinical competency or productivity of this group of undergraduate dental students.

Clinical competence/clinical credibility

This paper offers a report of a small-scale research study undertaken by the author to investigate teachers' perceptions of clinical competence and credibility. To provide a balance of opinions, senior clinicians' views on the subject were also obtained. Historically, the topic of nurse teachers' clinical competence and credibility has received varying degrees of exposure in the nursing literature. The major changes facing nurse education in this climate of uncertainty may have been responsible for the interest that has emerged recently. The survey used the interview method to collect data on aspects of interpretation of terms, relevant skills and United Kingdom Central Council for Nursing, Midwifery and Health Visiting recommendations related to clinical competence and clinical credibility. Similarities and differences of opinions which existed between the two groups of participants have been identified and discussed. Most clinical staff frequently made explicit reference to ‘patients’ in their answers, while there was no direct evidence of this in teachers' explanations.