Agricultural production involves the scaling of agricultural innovations such as disease-resistant and droughttolerant maize varieties, zero-tillage techniques, permaculture cultivation practices based on perennial crops and automated milking systems. Scaling agricultural innovations should take into account complex interactions between biophysical, social, economic and institutional factors. Actual methods of scaling are rather empirical and based on the premise of 'find out what works in one place and do more of the same, in another place'. These methods thus do not sufficiently take into account complex realities beyond the concepts of innovation transfer, dissemination, diffusion and adoption. As a consequence, scaling initiatives often do not produce the desired effect. They may produce undesirable effects in the form of negative spill-overs or unanticipated side effects such as environmental degradation, bad labour conditions of farm workers and loss of control of farming communities over access to genetic resources. Therefore, here, we conceptualise scaling processes as an integral part of a systemic approach to innovation, to anticipate on the possible consequences of scaling efforts. We propose a method that connects the heuristic framework of the multi-level perspective on socio-technical transitions (MLP) to a philosophical 'modal aspects' framework, with the objective of elucidating the connectedness between technologies, processes and practices. The resultant framework, the PRactice-Oriented Multi-level perspective on Innovation and Scaling (PROMIS), can inform research and policymakers on the complex dynamics involved in scaling. This is illustrated in relation to three cases in which the framework was applied: scaling agro-ecological practices in Nicaragua, farmer field schools on cocoa cultivation in Cameroon and 'green rubber' cultivation in Southwest China.

Aim.  This study contributes to the development of a valid and reliable instrument, the spiritual care competence scale, as an instrument to assess nurses’ competencies in providing spiritual care. Background.  Measuring these competencies and their development is important and the construction of a reliable and valid instrument is recommended in the literature. Design.  Survey. Method.  The participants were students from Bachelor‐level nursing schools in the Netherlands (n = 197) participating in a cross‐sectional study. The items in the instrument were hypothesised from a competency profile regarding spiritual care. Construct validity was evaluated by factor analysis and internal consistency was estimated with Cronbach’s alpha and the average inter‐item correlation. In addition, the test–retest reliability of the instrument was determined at a two‐week interval between baseline and follow‐up (n = 109). Results.  The spiritual care competence scale comprises six spiritual‐care‐related nursing competencies. These domains were labelled:
1 assessment and implementation of spiritual care (Cronbach’s α 0·82)
2 professionalisation and improving the quality of spiritual care (Cronbach’s α 0·82)
3 personal support and patient counseling (Cronbach’s α 0·81)
4 referral to professionals (Cronbach’s α 0·79)
5 attitude towards the patient’s spirituality (Cronbach’s α 0·56)
6 communication (Cronbach’s α 0·71). These subscales showed good homogeneity with average inter‐item correlations >0·25 and a good test–retest reliability. Conclusion.  This study conducted in a nursing‐student population demonstrated valid and reliable scales for measuring spiritual care competencies. The psychometric quality of the instrument proved satisfactory. This study does have some methodological limitations that should be taken into account in any further development of the spiritual care competence scale. Relevance to clinical practice.  The spiritual care competence scale can be used to assess the areas in which nurses need to receive training in spiritual care and can be used to assess whether nurses have developed competencies in providing spiritual care.

Aim.  To determine the effects of a course for nursing students on developing competence in spiritual care and the factors that might influence the effects. Background.  Studies suggest that role preparation in nursing for spiritual care is poor. For the assessment of competence, few or no explicit competency framework or assessment tools seemed to be used. Design.  Quasi‐experimental crossover design (pre–post‐test). Method.  The subjects were students from Christian nursing schools in the Netherlands (n = 97). The intervention consisted of a course in spiritual care. Competencies were measured with an assessment tool, the Spiritual Care Competence Scale. Data were analysed by t‐test procedures (paired‐samples t‐test). At T1 vignettes were added to assess the quality of the students’ own analyses. These data were analysed by a Mann–Whitney test. Regression analyses were performed on the influence of student characteristics on the subscales of the assessment tool. Results.  Ninety‐seven students participated in this study. Analysis showed statistically significant changes in scores on three subscales of the Spiritual Care Competence Scale between groups (T1) and over time for the whole cohort of students on all subscales (T2). Clinical placement showed as a negative predictor for three subscales of the Spiritual Care Competence Scale. Experience in spiritual care and a holistic vision of nursing both showed as positive predictors on certain competencies. A statistically significant difference was observed between groups in the student analysis of a vignette with explicit spiritual content. Conclusions.  The outcomes raise questions about the content of education in spiritual care, the measurement of competencies and the factors that influence competency development. Relevance to clinical practice.  The results provide nurse educators with insight into the effects of education in spiritual care on students’ competencies and help them consider a systematic place for spiritual care within the nursing curriculum.