https://www.infirmiere-canadienne.com/blogs/ic-contenu/2024/08/26/damelioration-de-la-qualite-nicaragua-partie-3
Nicaraguan hospital surveys nursing staff on applicability of Canadian competencies
By Martha Mercedes Casaya, López Rojas, Cristian Regina, Meza Oliva, Yellmy Melissa, Rivas Mercado, Jeffry Antonio, & Michele Trask
August 26, 2024
istockphoto.com/FatCamera
The development of procedural skills and the acquisition of competencies through clinical experience, with reflective practice as a key element, are central to nursing training.
Editor’s note: This is the third in a three-part series on a Nicaraguan hospital’s quality improvement initiative that began with implementing specialty competencies from the CNA Certification Program. These articles were originally written in Spanish (abstract available below). Part 1 was published on August 12. Part 2 was published on August 19.
Nursing, as a science, art, and profession, demands broad and systematized training within diverse professional contexts. The development of procedural skills and the acquisition of competencies through clinical experience, with reflective practice as a key element, are central to nursing training.
Supplied by Michele Trask
The hospital’s nursing personnel underwent evaluation through an intensive course on CPR, a training program that encompassed all processes based on evidence-based competencies.
This article presents the perceptions of nurses regarding the application of Canadian nursing competencies in hemodialysis, neonatal intensive care, and intensive care settings at the Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, a military and urban teaching hospital that provides tertiary care. This quality improvement initiative investigates the implementation process and its impact on nursing practice.
Background
The hospital embarked on an evidence-based approach aiming to enhance nursing practice through clinical competencies published by the Canadian Nurses Association (CNA). This was done with the permission of CNA both to use these competencies and to translate them into Spanish.
The hospital is the only one in the region that uses a competency-based management methodology with its nurses, and is also a pioneer at the national level.
For more information, read part 1 for a summary of how the hospital adapted CNA’s competencies for its own use, and part 2 for how the nursing staff implemented advanced CPR training.
Methods
A descriptive, qualitative evaluation was conducted in the hemodialysis, neonatal intensive care, and intensive care units. Thirty-three nurses participated in focus groups, discussing perceptions of Canadian nursing competencies in their own areas of practice. Data collection included interviews guided by predetermined questions, addressing perceptions, performance changes, applicability, and implementation processes.
| Nursing unit |
Number of participants |
| Hemodialysis |
9 |
| Neonatal intensive care |
18 |
| Intensive care |
6 |
| Total |
33 |
For the collection of information, a series of questions recommended by the Canadian project facilitator were asked:
- What did you initially think about the application of Canadian skills in your workplace?
- How has the performance of your duties changed since you started applying the Canadian competencies over the course of the project?
- Do you think the practice settings may be different between Canada and Nicaragua?
- Do you think the Canadian skills are applicable in your workplace?
- How do you think the Canadian competencies implementation project developed/proceeded in your unit?
- What were the benefits of implementing the Canadian competencies at the military hospital?
- What observations or recommendations do you have about this experience?
Three focus groups of 11 people each were carried out, consisting of nurses from the NICU, ICU, and hemodialysis unit. The focus groups lasted 50–65 min, during which the participants were invited to share their opinions.
Results
Fifty-four point five per cent (54.5%) of the focus group participants were from the NICU, 18.2% from the ICU, and 27.3% from the hemodialysis unit; 66.7% are female and 33.3% were male.
Tool to strengthen knowledge
Thirty-nine per cent (39%) reported that they thought the Canadian competencies were a tool to strengthen knowledge; 18% reported not knowing what the competencies were; and 15% reported that the competencies were a strategy to know the level of knowledge and a methodology for self-assessment and evaluation. One of the nurses stated: “I had no idea that it was a competency tool; after the first meeting and the workshops, I realized that they are competencies and that they help in the care that we provide to the patient, being a tool essential for professional development.”
Improved performance
In the interview, 33% of the nurses reported that they have improved their performance in their nursing functions as a result of the implementation of the Canadian competencies; 30% reported that it helped them reinforce their knowledge; and 15% said that it helped them provide better care. One of the opinions of the nurses was: “... it helps us to measure ourselves as nurses through self-assessment, since now there is a tool that helps us to measure ourselves and improve according to the results we obtain.”
Analysis revealed positive perceptions of Canadian nursing competencies among the nurses. The majority reported improvements in performance, knowledge reinforcement, and enhanced patient care. Despite differences in practice settings, participants affirmed the applicability of Canadian competencies. Perceived strengths of the quality improvement project included knowledge acquisition, institutional support, and improved teamwork.
Little difference between Canada and Nicaragua
According to the responses to the interview, 67% reported that there is no difference between the environments of Canada and Nicaragua regarding applicability of the Canadian competencies. Twenty-seven per cent said that if there is a difference, the opinion was that the mindset of the nurse has a lot to do with the culture in health care, and these attitudes may differ between the two countries.
Six per cent remarked that we are still in the process of ensuring that the environments are similar. When giving his opinion, one of the nurses said: “They are not different, because the hospital is a hospital of excellence and it tries to provide better care in infrastructure and technological equipment, with highly qualified national and international personnel.”
One hundred per cent of the nurses interviewed reported that the Canadian competencies are applicable in the Hospital Militar Escuela Dr. Alejandro Dávila Bolaños. The opinion that stood out the most was: “They can be applied, since the Canadian accreditation is being implemented at our hospital. It also helps us to be aware of the standards, as it is something that was not done before now. It helps us to have more communication with the patient, family, and health team.”
First step: self-assessment
According to the interviews, 52% of the nurses indicated that the implementation of the Canadian competencies started with a self-assessment and then an evaluation of the unit leader. Eighteen per cent carried out a survey of patients, relatives, and other nurses who participated in the implementation of the competencies; 15% reported that a selection of personnel was carried out, then a personal self-evaluation, and then an evaluation by the unit leader.
One of the opinions that stood out was “A self-evaluation is carried out [regarding] knowledge, attitudes, strengths, and an evaluation of the head of the unit. This helps us know what is being done well and where improvements can be made.”
Acquired and strengthened knowledge
Regarding the strengths of the implementation of the competencies, the opinion of the interviewed nurses was that 27% reported they acquired and strengthened their knowledge; 21% said they had support from the head of the institution; and 15% reported strengthened teamwork and effective communication among nurses and between nurses and physicians.
One notable opinion was: “Acquisition of new knowledge about procedures that we did not previously carry out helps us assert the importance of the nursing staff in an internationally accredited hospital. We also strengthened and updated knowledge of what we already knew — this is very important, because nursing is one of the sciences that are integral, and information is constantly changing.”
Expand training to all nursing staff
The recommendation that was most highlighted (30%) was that all nursing staff be trained with the competencies of their established areas; 18% stated that when applying the evaluation instrument, it was necessary to be more specific with the criteria.
Twelve per cent (12%) indicated a desire to certify nurses in the competencies of their areas of work. One expressed the opinion: “Observation: we have had a ton of medical support in the trainings, [and] we could not have done this without our physician colleagues. Recommendation: schedule skills training to be carried out in different areas to improve skills and abilities.”
(Contact author Michele Trask for more details about the research findings.)
Discussion
Participants expressed satisfaction with the implementation of Canadian competencies, recognizing their contribution to nursing knowledge and patient care. Effective communication between medical and nursing staff was enhanced, emphasizing collaborative, patient-centred care.
This project, in addition to emphasizing the need for strengthening the knowledge and skills of nurses, has also improved the consolidation of patient safety strategies, with a focus on reinforcing person- and family-centred care.
Conclusion
The implementation of Canadian nursing competencies at the Hospital Militar Escuela Dr. Alejandro Dávila Bolaños signifies a commitment to excellence in nursing practice. Collaboration with Accreditation Canada facilitated the adoption of evidence-based practices, ensuring high-quality care. Future studies will explore perceptions of competencies in other nursing specialties, further advancing nursing excellence in the region.
This evaluation enabled us to learn about differing opinions regarding the implementation of this project in other nursing units. In future, similar evaluations will be carried out on nurses’ perceptions regarding Canadian competencies for other specialties that were expanded in our institution, including cardiovascular nursing, palliative care nursing, and surgical nursing.
RESUMEN
Objetivo
El objetivo de este artículo fue conocer la percepción de las enfermeras sobre la aplicabilidad de las competencias de enfermería especializada canadiense en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños.
Método de estudio
Se trata de un estudio descriptivo, cualitativo-cuantitativo, prospectivo, transversal. El área de estudio son las unidades de UCIN, UCI y Hemodiálisis del Hospital Militar Escuela Dr. Alejandro Dávila Bolaños. La unidad de análisis fueron los colaboradores de enfermería con título de licenciatura. Para llevar a cabo este artículo se realizó la recolección de datos mixtos a través de entrevistas en grupo focal con colaboradores de enfermería, civiles y militares.
Resultados
Los colaboradores de enfermería, en términos generales, manifiestan sentirse satisfechos con la implementación de las competencias canadienses en su unidad de trabajo, ya que esto fortalece los conocimientos, habilidades y destrezas, mejorando los cuidados de enfermería, brindando calidad y calidez a la seguridad del paciente.
Conclusiones
Los resultados de la percepción de las enfermeras sobre la aplicabilidad de las competencias canadienses de enfermería especializada en el Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, teniendo respuestas satisfactorias en el grupo focal realizado.
Martha Mercedes Casaya, RN, BSN, MHA, is the unit chief, hemodialysis, at the Hospital Militar Escuela Dr. Alejandro Dávila Bolaños in Nicaragua.
Jeffry Antonio Rivas Mercado, RN, BSN, MN, is a professor in the School of Nursing at the University of Turnivia Garcia Otero of Nicaragua.
Michele Trask, BSN, MIPH, RN, FCAN, CHE, EDAC, is an adjunct professor at the University of British Columbia’s School of Nursing.
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