Newly graduated nurses need to demonstrate high levels of competencies when they enter the workplace. A competency-based approach to their education is recommended to ensure patients' needs are met. A continuing education intervention consistent with the competency-based approach to education was designed and implemented in eight care units in two teaching hospitals. It consists of a series of 30-min reflective practice groups on clinical events that newly graduated nurses encountered in their practice. It was evaluated using a descriptive longitudinal evaluative research design, combining individual and group interviews with stakeholders, the analysis of facilitators' journal entries, and a research assistant's field notes. The results suggest that issues associated with the implementation of the continuing education intervention revolved around leadership for managers, flexibility for nursing staff, and role shifting for the facilitators. Newly graduated nurses who participated in the study noted that the reflective practice sessions contributed to the development of both clinical reasoning and leadership. Nursing managers stated the advantages of the intervention on nurses' professional development and for the quality and safety of care. Following the end of the study, participants from two units managed to pursue the activity during their work time.
Background Compassionate communities are rooted in a health promotion approach to palliative care, aiming to support solidarity among community members at the end of life. Hundreds of compassionate communities have been developed internationally in recent years. However, it remains unknown how their implementation on the ground aligns with core strategies of health promotion. The aim of this review is to describe the practical implementation and evaluation of compassionate communities. Methods We undertook a scoping review of the empirical peer-reviewed literature on compassionate communities. Bibliographic searches in five databases were developed with information specialists. We included studies in English describing health promotion activities applied to end-of-life and palliative care. Qualitative analysis used inductive and deductive strategies based on existing frameworks for categorization of health promotion activities, barriers and facilitators for implementation and evaluation measures. A participatory research approach with community partners was used to design the review and interpret its findings. Results Sixty-three articles were included for analysis. 74.6% were published after 2011. Health services organizations and providers are most often engaged as compassionate community leaders, with community members mainly engaged as target users. Adaptation to local culture and social context is the most frequently reported barrier for implementation, with support and external factors mostly reported as facilitators. Early stages of compassionate community development are rarely reported in the literature (stakeholder mobilization, needs assessment, priority-setting). Health promotion strategies tend to focus on the development of personal skills, mainly through the use of education and awareness programs. Few activities focused on strengthening community action and building healthy public policies. Evaluation was reported in 30% of articles, 88% of evaluation being analyzed at the individual level, as opposed to community processes and outcomes. Conclusions The empirical literature on compassionate communities demonstrates a wide variety of health promotion practices. Much international experience has been developed in education and awareness programs on death and dying. Health promotion strategies based on community strengthening and policies need to be consolidated. Future research should pay attention to community-led initiatives and evaluations that may not be currently reported in the peer-review literature.
Manuscrit reçu le 20 septembre 2014 ; commentaires éditoriaux formulés aux auteurs le 23 mai et le 6 juin 2015 ; accepté pour publication le 8 juin 2015Résumé -Contexte : Pour guider les programmes de formation, il est nécessaire de pouvoir poser une évaluation diagnostique du raisonnement clinique des infirmières. Or, les outils disponibles à cet effet présentent des problèmes majeurs. Abstract -Background:The development of training programs requires an evaluation of nurses' clinical reasoning. However, there are issues with the evaluation, which uses existing tools. The script concordance test is a promising and innovative evaluation alternative. Purpose: To explore the possibility of using questions from a script concordance test as an evaluation tool in assessing nursing students' clinical reasoning abilities. Data: Transcripts of interviews with nurses and nursing students (n = 55) from a previous study [1] were used. During the interviews, participants were asked to share their thoughts aloud while taking a script concordance test. Analysis: Transcripts were coded to identify thinking categories and strategies used by participants to answer questions from the script concordance test. Q-matrices were then developed to formalize relationships between thinking categories/strategies and the test questions in each group of participants. Results: Each group used different thinking categories/strategies to answer questions in the script concordance test. These questions could help assess nursing students' strengths and weaknesses as they relate to their development level. The reasoning of nursing experts was so unlike that of students that they could not be used as a benchmark for diagnostic evaluation. Conclusion: Depending on groups student nurses use different thinking categories and strategies, and some SCT questions show a diagnostic potential in evaluating nurses' clinical reasoning per level (1st, 2nd and 3rd year).
La formation continue des infirmières nouvellement diplômées (IND) dépend de plusieurs facteurs reliés aux caractéristiques des compétences à développer, de la population cible et du contexte organisationnel. Peu d’études décrivent à la fois comment les infirmières développent leurs compétences et comment les établissements favorisent ce développement. Les objectifs de cet article sont de décrire les comportements que les IND utilisent pour développer leurs compétences de raisonnement et de leadership ; et de documenter les éléments organisationnels qui facilitent ce développement. Méthode. Des entrevues individuelles ont été effectuées auprès d’infirmières (n=34) à l’aide d’une grille d’entrevue semi-structurée et deux entrevues de groupes ont été réalisées auprès d’infirmières (n=7) et de gestionnaires (n=19) dans deux hôpitaux universitaires de l’Est du Canada. Les résultats montrent que les infirmières se développent essentiellement en réfléchissant sur leur pratique professionnelle dans leur milieu de travail. Or, l’absence de temps de réflexion dans l’espace de travail est un obstacle considérable alors que le leadership des gestionnaires est un atout important.
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