Exploring nursing competence to care for older patients in municipal in‐patient acute care: A qualitative study

Abstract

Aim:To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care.Background: An increasingly complex and advanced primary healthcare system requires attention to the extent of nursing competence in municipal services. However, competence in complex and advanced care settings must be explored using perspectives which acknowledge the complexity of nurses' performance.Design: A phenomenological hermeneutic, qualitative approach with individual indepth interviews was used. COREQ reporting guidelines have been applied. Methods:A sample of eight nurses and two physicians employed in municipal in-patient acute care units (MAUs) were purposively recruited to participate. Data were collected between May and June of 2017. Analysis and interpretation were conducted systematically in three steps: naïve reading, structural analysis and comprehensive understanding. Findings: Two main themes were revealed. The first was the following: "The meaning of the individual nursing competence" including the themes "Having competence in clinical assessments, decision-making, and performing interventions"; "Having competence to collaborate, coordinate and facilitate"; and "Being committed." The second was the following: "The meaning of environmental and systemic factors for nursing competence," included the themes "Having professional leadership"; "Having a sufficiently qualified staff"; and "Working in an open, cooperative and professional work environment." Conclusion: Individual nursing competence in MAUs should include the capability to detect patient deterioration and to care for older patients in a holistic perspective. In addition, the professional environmental culture, supportive leadership and systemic factors seemed to be crucial to success. Relevance to clinical practice: This study illustrates the nurses' responsibility for older patients' safety and quality of care in the MAUs. These findings can act as a foundation for the development and adaptation of educational programmes

Nursing competence in municipal in-patient acute care in Norway: a cross-sectional study

“…Emergency nursing 0 (0-1) 1 (0-1.75) 0 (0-1) 0 (0-2) 0 (0-1) 0 (0-1) 0 (0-1) 0 (0-1) 0 (0-1) acknowledged and supported by a professional leadership [8,11,43] The benefits of having collegial support to handle the workload is described in several studies [5,42,44]. This includes, among other things, to assess and discuss patients and different situations in order to make accurate decisions and interventions, as well as access to qualified second opinions [5,42,44].…”

“…The questionnaire was based on a previous qualitative study which explored critical aspects of nursing competence to care for older patients in MipACs in Norway [11]. That study revealed the importance of professional nurses in the staff, holding advanced competence, particularly within specialisation in emergency, geriatric and psychiatric nursing in these units.…”

“…Furthermore, the study revealed that sufficient professional nurses in staff on duty enabling collegial support, opportunities for second opinions in patient assessment and control, e.g. when administering medication, was perceived as crucial for care quality and patient safety [11]. The questionnaire contained five items to identify characteristics of the MipAC units included in the study and ten items to give an overview of nursing competence.…”

“…Research emphasises that there is a positive association between nursing competence and education [5,21]. Vatnøy et al [11] explored critical aspects of nursing competence in the context of the MipAC, and they found that in addition to the individual nurse's attributes, nursing competence is also dependent on environmental and systemic factors in which a sufficiently qualified nursing staff is crucial [11]. The link between staffing level, i.e.…”

“…Advanced nursing competence in the context of MipAC is not defined although competence within emergency, geriatric, and mental health/psychiatric nursing is suggested as crucial [11,18]. In addition, is it stated that the role of advanced practice nursing in primary health care comprises medical competence at a level beyond bachelor's degree in nursing [4].…”