Centre for Caring Research, Southern Norway and Department of Health and Nursing Science, University of Agder, Grimstad, Norway.
Department of Health and Nursing Science, University of Agder, Grimstad, Norway.
J Clin Nurs. 2019 Sep;28(17-18):3339-3352. doi: 10.1111/jocn.14914. Epub 2019 Jun 2.
To identify critical aspects of nursing competence to care for older patients in the context of municipal in-patient acute care.
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.
A phenomenological hermeneutic, qualitative approach with individual in-depth interviews was used. COREQ reporting guidelines have been applied.
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.
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."
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.
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 to accommodate requirements for nursing competence in MAUs. The broad perspective of nursing competence can give directions for quality improvements in MAUs.
在市级住院急性护理的背景下，确定护理老年人患者能力的关键方面。
日益复杂和先进的初级保健系统需要关注市政服务中护理能力的程度。然而，必须从承认护士绩效复杂性的角度探讨复杂和先进护理环境中的能力。
采用现象学诠释学、定性方法和个人深入访谈。已应用 COREQ 报告指南。
有目的招募了 8 名护士和 2 名在市级住院急性护理单位（MAU）工作的医生参加。数据于 2017 年 5 月至 6 月间收集。分析和解释分三个步骤进行：初步阅读、结构分析和全面理解。
揭示了两个主要主题。第一个是：“个人护理能力的意义”，包括以下主题：“具备临床评估、决策和干预的能力”；“具备协作、协调和促进的能力”；“有承诺”。第二个是：“护理能力的环境和系统因素的意义”，包括以下主题：“有专业领导力”；“有足够合格的员工”；“在开放、合作和专业的工作环境中工作”。
MAU 中的个人护理能力应包括发现患者恶化的能力，并从整体角度照顾老年患者。此外，专业环境文化、支持性领导和系统因素似乎是成功的关键。
本研究说明了护士在 MAU 中对老年患者安全和护理质量的责任。这些发现可以作为制定和调整教育计划的基础，以适应 MAU 中护理能力的要求。护理能力的广泛视角可以为 MAU 的质量改进提供方向。
