A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale. Statements not reaching consensus (agreement ≥80%) were modified and included in a second (final) round. The first survey was completed by 63% ( n = 86/137) of participants and 84% ( n = 72/86) of these participants completed the second survey. Most statements ( n = 45) achieved agreement after the first survey; one statement was dropped and two were combined following the second round. The final list of competencies consists of 47 statements across six domains (professionalism; clinical practice; communication; collaboration and partnership; quality assurance, evaluation, and research; leadership). National competencies will help strengthen the RN workforce within primary care, improve team functioning, and support role integration/optimization.

Learning needs assessment is an important stage of every educational process that aims to inform changes in practice and policy for continuing professional development. Professional competencies have been widely used as a basis for the development of learning needs assessment. The Canadian Community Health Nursing Standards of Practices (CCHN Standards) were released in 2003. However, it is not known whether community health nurses (CHNs) have the educational background to enable them to meet these standards. This article reports on the development of a learning needs assessment questionnaire for CHNs. Exploratory and confirmatory factor analyses were conducted to examine the consistency of factors underpinning the CCHN Standards. Also, validity and reliability of the questionnaire were evaluated using appropriate techniques. This process resulted in a valid and reliable CHN learning needs assessment questionnaire to measure learning needs of large groups of practitioners, where other forms of measurement cannot be feasibly conducted.

Professional caring is the essence of nursing practice. Reflection on personal assumptions and beliefs challenge stereotypic views that influence professional caring and nursing care. An innovative educational pedagogy known as service learning creates an opportunity for students to reflect on self in the context of service to others; it is through this pedagogy that personal assumptions and beliefs are challenged as students become registered nurses. A qualitative descriptive study engaged undergraduate first and second year nursing students through interviews and reflections. The purposes of this study were to describe students' perception of self and caring in service learning, any changes in the perceptions of self over time, and the connection of self to others. Results identified three major themes: understanding self, becoming a nurse and learning to care with increasing depth over the two years. Implications for nursing curriculum and further research are discussed.

As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.

Before the "Bridge to Discharge" innovation, hospital and community services were largely separate, and the consumer group was rarely included in direct clinical issues. The "Bridge to Discharge"project involves a partnership among a psychiatric hospital schizophrenia program, a public health program, and a consumer group to assist indi viduals who had experienced lengthy psychiatric admissions reintegrate into the com munity. This article reports the qualitative evaluation of client and staff responses every other month regarding the changes in this project. Clients described "hope"for a life outside the hospital and the importance of working with staff they knew. Role changes for both the inpatient nurses and the public health nurse reflect role expan sions and a broader attention to client issues. Partnerships among hospital, communi ty, and consumer groups have the potential to assist clients to make the transition to successful community living. Understanding the changes over time resulting from inno vations will assist nurses and others in planning for appropriate services and sup ports. ( J Am Psychiatr Nurses Assoc [1998]. 4, 128-133)