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Competency in Nursing :A Concept AnalysisSomyah Alqarni 441203931 Bayan Alqarni 441203803Fatmah Alzahrani 441203884Amnah Aluneizi441203945King Saud University / College of NursingAbstractNursing competency is defined as a holistic lens and behavior that reflects the knowledge, skills, attitude, and judgment necessary for effective performance in the profession. This article discusses the role of nursing competency. Concept analysis process was used to assess various elements of competency. The defining attributes of competency consider to be the application of skills in all aspects for the practice role, instruction that focuses on specific competencies, increasing levels of competency, practice-based learning self-assessment, accountability of the learner, and individualized learning experience (Liu & Aungsuroch , 2018). Keywords: Concept analysis, Competency, Nursing education, Practice.IntroductionNursing competency includes core skills needed to fulfill one’s role as a nurse. It is therefore important to define nursing competency clearly in order to establish a basis for the curriculum for nursing education. While the concepts surrounding nursing, competency are important to improve the quality of nursing, they are not yet fully developed. Challenges remain exist in establishing definition for competency in nursing education ( Fukada ,2018 ) .However , Measuring and validating nursing competency in the healthcare sector will help ensure that patients receive healthy, evidence-based, and high-quality care .The complexity of the healthcare system requires that nurses should engage in training programs to ensure that they have the necessary knowledge, skills and capacity to provide treatment individually and as members of the healthcare team(Dickerson, &Chappell, 2016 ) .AimTo understand the concept of nursing competency and its role in nursing education and to explore the uses and attributes of the competency in nursing.ConclusionMethodA literature search was conducted by using various Databases including PUBMED, EBSCOHOST, CLINCALKEY. In addition to use Google scholar to review nursing education and competency in nursing education literatures between 2013 and 2018, by using different keywords such as competency and nursing education . Ten articles used to conduct this concept analysis by applying Walker and Avant concept analysis method with eight steps to analyze the concept of competency in nursing starting with select concept , determine the purpose of doing concept analysis ,identify the uses of concept , defining characteristic of concept ,developing model case that represent all concept attributes , two additional cases borderline and contrary finally, identify the antecedents and consequences of the concept (Nuopponen , 2010).FindingsRole of competency One of the main problems of the role of the educator is to assess the performance of the nursing student, determine if the goals of clinical teaching are being met, and validate that the student is a secure practitioner. It can be a task to evaluate clinical competence and to determine the development of professional knowledge, abilities and attitudes (KSAs). Objectively assessing the clinical skills of learners can be the most daunting of all the responsibilities of an educator (Leigh, Stueben,Harrington,&Hetherman,2016) Most nursing colleges currently depend on a multitude of techniques to assess clinical skills. Ideally, clinical competency assessment of a student is based on sound practice measurement and predetermined learning goals that are obviously communicated and understood by both teachers and students. Clinical assessment normally involves both formative and summative evaluations. Formative evaluation is underway, providing timely feedback to learners on fields that need to be improved, allowing the student to enhance their efficiency. A more formal formative evaluation with both verbal and written feedback is usually conducted at the mid-term. In essence, the final clinical assessment is summative. An unsatisfactory or unsuccessful grade in the clinical experience outcomes in a failure in the course in most nursing colleges. Therefore, clinical teachers must ensure fair and unbiased evaluations (Leigh et al.,2016). Nursing, and indeed all healthcare jobs, must recognize and address the challenges presented in attaining a fair, objective and precise measurement of the clinical competencies of learners. While the faculty may use a range of instruments and techniques to determine whether the performance of learners meets the requirements established, clinical assessment continues a complicated and incomplete method (Leigh et al.,2016). The role of competency in education has risen dramatically as the gap between education and practice has been recognized by health care employers and teachers. Factors such as absence of financing to update the nursing curricula and a restricted concentrate on teaching in academic health centers have been ascribed to the gaps between education readiness and real practice (Shargi,Alami,Khrosavan,Mansori,&Ekrami,2015)The origin of competency in Nursing Education The competency based educational assessment (CBE) has started before more than three decades and is widely adopted to use by different medical and health disciplines (Leung, Trevena &Waters, 2016). Nursing education around the world moved from hospital-based practice to a competence-based curriculum throughout the 1980s and 1990s (Leung et al.,2016). CBE is seen as a process of teaching learning that emphasizes the achievement of the outcome in which an individual must know and be able to do certain tasks (Leung et al.,2016). Throughout the past 20 years, a variety of national initiatives have indicated the importance of improving and maintaining safety in the healthcare setting that would be through safe practice (Dickerson, &Chappell, 2016 ).Some National Academy of Medicine reports, such as Health Professions Education: A Bridge to Quality and The Future of Nursing Leading Change, Advancing Health, emphasize core competencies in order to safe practice and the importance of nursing education that focuses on development of knowledge, skills, and abilities to practice safely . These reports have worked as the foundation for subsequent initiatives to assess and improve the competence of nurses and other healthcare team members (Dickerson &Chappell ,2016). As nursing education progresses to tertiary settings, the nature of teaching and application has also changed. Nursing courses and programs for enrolled and registered nurses remain based on abilities, and attitudes that nurses are supposed to show in a broad variety of situations and environments in the workplace. Thus, some professional programs and courses such as nursing have been introduced to competency-based education ( Salem,Aboshaiqah, Mubaraki,& Pandaan , 2018 ).National Associations and Agencies have established multiple demands for skilled and competent nursing practice in health care system. The Joint Commission for Accreditation of health care Organizations requires evaluation, maintenance and continues improvement of clinical competence ( Salem et al., 2018 ) .The goal of the College of Nursing is to provide safe secure, competent and ethical nursing care, Nursing College acknowledged the need for new approach to attain this goal which is competency based education ( Salem et al., 2018 ).Use of Competency as A Concept To understand the “true nature use of the concept”. Use the concept are to be examined from several perspective (Walkera&Avant,2011). Defined by the Oxford English Dictionary (2012) as “the ability to do something successfully or efficiently.” Use of the concept is a stage in the process of skill acquisition and knowledge development in which on has sufficient background knowledge to permit the use of judgment, planning, coping and analysis. A skill set that is applied to tasks. (Hansen &Bratt, 2015).It is like the substantial with which to describe the nursing role in terms of discrete, assessable elements of behavior or outcomes performed by a nurse. Identifies competency as having the capacity to give direction to all who are involved in staff development, recruitment, training, preparing, examination, promotion and succession planning. Give understanding into region of expert practice that can be actualized given the ability level of nursing staff and advancement needs.Use of competency statements can also facilitate individualized learning by enabling practitioners to reflect on their current practice and become self‐directing. Closing the points of interest, help judgment concerning performance. Managing abilities and characteristics required in maturely, brilliantly and expertly managing patient and their problem, thus frequently stressing detriment of learning and comprehension. Aid in career and succession planning, analyze skills and able to identify the current and projected deficiencies in skills, improve workforce flexibility. Support the integration of aware all the practice and provide a basis of compensation. (Ličen & Plazar,2015).Defining Attributes of Nursing CompetencyNursing competency according to one concept analysis study can be divided into three theory: trait theory, holism , and behaviorism . Trait theory views competency as individual traits important for effectively performing tasks (critical skills and knowledge, etc.). Holism shoes competency as a group of elements, including skills, knowledge , attitudes, values and thinking ability. Behaviorism consider competency as an ability to perform skills, and individual is evaluated by demonstration skills (Fukada,2018).For nursing competency, nurses must have the skills and personal traits important to effectively perform their duties while multiple elements must be integrated including knowledge, attitude, techniques, values and thinking ability that are necessary in specific situation. These elements can be divided into three categories: personal traits important for nursing, professional behaviours and attitudes, and the professional knowledge and skills (Fukada,2018). Thus, nursing competency characteristics include a variety of abilities , performance traits demonstrated by a competent nurse possesses these skills and abilities can be referred as nursing competency(Fukada,2018).Cases of a Competency in Nursing EducationModel CaseNursing College R is known for its innovative focus on the students and their clinical performance Clearly defined competencies and provide a guideline, and students must demonstrate mastery of lower-level competencies before moving into higher-level content. Students are expected to demonstrate the mastery of knowledge, interpersonal skills, decision-making, and psychomotor skills. Nursing College R represents a model case that incorporates the defining attributes of competency-based education.A borderline caseA registered nurse to a bachelor’s degree in nursing at a large university is a web-based program that individualizes degree plans and clinical experience. At the beginning of the curriculum, students begin building portfolios and maintain a current portfolio throughout. Courses are designed specifically for registered nurses and the advanced placements or graduate courses substitution based on previous experience is encouraged. Testing is not a part of course, but students must write at least one paper with obviously specified requirements for each courseA contrary case Nursing School A is a traditional didactic based program in which the primary method of evaluating students for the first 2 years of the 4 years program is to test classroom content. The second half of the program includes a clinical component that requires students to complete nursing skills before the end of the program. Student may either pass or fail each course’s clinical components and the feedback is not provided regarding their clinical performance. In this imaginary nursing program, all defining attributes of competence are absent.Antecedents and Consequences Antecedents for competency are educational programs, students, teachers of nurses, and nursing practice. Consequences of competency remain largely undetermined. Competence in nursing and education is likely to stay essential in the foreseeable future (Pijl-Zieber , Barton , Konkin , Awosoga & , Caine , 2014 ) . The current literature shows that a consequence of focus on competency in nursing education and practice can have direct impact on positive outcomes for patients and decreases the healthcare costs (Dickerson, & Chappell, 2016).Empirical ReferenceIn the concept analysis of nursing competence is to define the defining characteristics with the last stage empirical references. Empirical references show how to measure the concept and validate its existence (Walker & Avant 2011). The critical characteristics are very frequently recognized as the empirical referents (Walker & Avant1995). They also point out that the critical characteristics may be similarly nebulous if the idea being analyzed is imprecise. The abstract nature of the idea of competence and the qualitative nature of the critical characteristics indicate that this needs to be reflected and qualitative methods used to explore the idea. However, before using the competence model, the idea requires to be obviously articulated without a clear comprehension of the notion of competence.ConclusionIn conclusion, Nursing competency is defined as a holistic lens and behavior that reflects the knowledge, skills, attitude, and judgment necessary for effective performance in the profession. This article discussed the origin, role, attributes, uses, cases and empirical reference of nursing competency. Walker and Avant concept analysis method was used with eight steps to analyze the concept of nursing competency. It is important to define and understand the concept of nursing competency clearly in order to establish a basis for the curriculum for nursing education. While the concepts surrounding nursing, competency are important to improve the quality of nursing.ReferencesDickerson, P., & Chappell, K. (2016). principles of evaluating nursing competence. TD: Talent Development, 70(2), 44–48.Fukada, M. (2018). Nursing competency: definition, structure and development. Yonago acta medica, 61(1), 001-007.Hansen, J., & Bratt , M. (2015). Competence Acquisition Using Simulated Learning Experiences: A Concept Analysis. Nursing Education Perspectives (National League for Nursing), 36(2), 102–107.Leigh, G., Stueben, F., Harrington, D., & Hetherman, S. (2016). Making the case for simulation-based assessments to overcome the challenges in evaluating clinical competency. International journal of nursing education scholarship, 13(1), 27-34.‏Leung, K., Trevena, L., & Waters, D. (2016). Development of a competency framework for evidence-based practice in nursing. Nurse Education Today, 39, 189–196. Ličen, S., & Plazar, N. (2015). Identification of nursing competency assessment tools as possibility of their use in nursing education in Slovenia—A systematic literature review. Nurse education today, 35(4), 602-608.‏Nuopponen, A. (2010). Methods of concept analysis-a comparative study. LSP Journal-Language for special purposes, professional communication, knowledge management and cognition, 1(1).Pijl-Zieber.E.M , Barton.S. , Konkin.J , Awosoga.O,& Caine . V.(2014) .Competence and competency-based nursing education: Finding our way through the issues. Nurse Education Today 34 , 676–678.Salem, O.A., Aboshaiqah, A.E., Mubaraki, M.A. and Pandaan, I.N. (2018) Competency Based Nursing Curriculum: Establishing the Standards for Nursing Competencies in Higher Education. Open Access Library Journal , 5: e4952.Sharghi, N. R., Alami, A., Khosravan, S., Mansoorian, M. R., & Ekrami, A. (2015). Academic training and clinical placement problems to achieve nursing competency. Journal of advances in medical education & professionalism, 3(1), 15.‏Ying ,L and Yupin,A . (2018) .A“Current Literature Review of Registered Nurses’ Competency in the Global Community.”. Journal of nursing scholarship, vol. 50, no. 2, pp. 191–199., doi:10.1111/jnu.12361.

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