Limits of professional competency in nurses working in Nicu

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_med-2018-0060_s_006_w2aab3b8d302b1b7b1aab1c15b1Aa"><jats:title /><jats:p>Our study aimed to find out the views of nurses working in neonatal intensive care units about the limits of professional competencies and to identify situations where the limits are crossed.</jats:p></jats:sec><jats:sec id="j_med-2018-0060_s_007_w2aab3b8d302b1b7b1aab1c15b2Aa"><jats:title>Methods</jats:title><jats:p>The research employed the focus group method. For this research we had three focus groups with nurses working in neonatal intensive care units. The results of the study were analysed using the thematic analysis described in Braun and Clarke.</jats:p></jats:sec><jats:sec id="j_med-2018-0060_s_008_w2aab3b8d302b1b7b1aab1c15b3Aa"><jats:title>Results and conclusions</jats:title><jats:p>Based on our research findings, it can be stated that the limits of professional competence of nursing staff working in neonatal intensive care units are defined and clear, but nurses often perform actions exceeding their competencies. This is usually done on the initiative of the nurses themselves, in cases of the deterioration of the state of the newborn, or when doctors delegate their functions to them. Confidence expressed by doctors leads to conflicting feelings of concern and, at the same time, pride in themselves.</jats:p></jats:sec>

Neonatal Nurse and Midwife Competence Regarding Pain Management in Neonates

“…Of the 19 articles, 5 continents and 11 countries are represented in terms of geographical distribution. Of these, 6 were published in Brazil,20–22,24,35,41 3 from Egypt,26,27,36 2 from Iran,23,42 and one each from Jordan,43 Norway and Sweden,44 Canada,45 China,25 Rwanda,28 Poland,29 Lithuania,16 and Denmark30 (see Figure 2). None of the studies conducted in the United States, however, concentrated on “competence” among NICU nurses/midwives.…”

“…Sample sizes ranged from 10 to 355, with 10 studies using sample group sizes of fewer than 50 participants and 9 articles had greater than 100 participants (2 of which had >300). Some studies were unclear about the inclusion and exclusion criteria 16,21,23,26,28–30,41,44. Moreover, one study had a wide range between the years of nurses'/midwives' clinical experience (SD = 5.39) 35.…”

“…Nurse Competence Regarding Pain Management in Neonates remaining 5 articles were qualitative descriptive studies, including field work, semistructured interview, and focus group studies. 16,[20][21][22]24 The majority assessed nurses' and midwives' competence (n = 15) using self-reported questionnaires that were developed by the researchers. These typically consisted of multiple-choice, yes/no, or openended questions.…”

“…From a total of 19 studies, it was found that the barriers to effective neonatal pain management can be divided into 3 main factors, which are related to (a) nurses and midwives, including personal and professional experience 41 and professional education/ training 23,25,27 ; (b) pain assessment in neonates 21,22,23,25,35 ; and (c) organizational culture, including staffing/workloads, as well as guidelines/ protocols, 22,23,[25][26][27] and hierarchy. 16,44 Work experience was the demographic variable that associated most significantly with the nurses' and midwives' attitudes or perceptions of neonatal pain assessment and management. 41 Some studies revealed that the group of nurses with the least experience in the NICU (0-2 years) had more misconceptions than the other groups concerning neonates' pain expression.…”

“…44 In addition, it was found that the limits of professional competence of nursing staff working in the NICU often performed actions exceeding their own competence when faced with emergency or life-threatening situations or a practice dilemma/conflicting feeling. 16 In these complex situations, doctors tended to delegate larger functions and entrusted such procedures to experienced nurses. Specifically, in the Swedish context, nurses spent more time in the NICU at the bedside with infants and parents and had significantly more opportunities to observe the infants' pain experience compared with the physicians.…”