Development of an evaluation tool for clinical competence of community service nurses in North West Province, South Africa
Matlhaba, Kholofelo Lorraine
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Introduction and Background: Nurses’ ability to demonstrate competence is necessary to meet the requirements of the healthcare organisations. In many countries, measures and initiatives are put in place to prepare newly qualified nurses for their roles as professional nurses. As of 2008, national requirements make it mandatory for nurses who have qualified as a General, Psychiatric and Community and Midwifery nurse to complete a 12-months’ community service prior to their registration as professional nurses. During this community service, community service nurses (CSNs) are assigned to different public healthcare facilities. However, since the introduction of this community service, little has been done to evaluate their clinical competence and whilst it is expected of them to be competent practitioners when resuming their duties as professional nurses. It was therefore important for the researcher to think of ways to evaluate their clinical competence during community service, hence the need to develop and validate a clinical competence evaluation tool in North West Province, South Africa. Research purpose: The purpose of this research was to develop and validate the clinical competence tool to evaluate clinical competence of community service nurses in North West Province, South Africa. Methodology: An exploratory sequential mixed method research design with multi phases was followed to address the research problem. The design involved three phases, namely, empirical phase, which addressed the problem analysis and planning, information gathering and synthesis, and design; development phase that addresses the development of the tool and the validation phase which addresses the validation of the developed tool, consisting of four sections. In phase one, the researcher started with qualitative design of which the results guided the formulation of quantitative data collection tool. Phase two and three are comprised of the development and validation of the proposed clinical competence evaluation tool. Information from phase one and its multi stages was used to develop the tool. The developed Clinical Competence Evaluation Tool (CCET) was grounded on Patricia Benner’s “From Novice to Expert” model. The tool development process followed the four steps on tool development described by LoBiondo-Wood and Haber. Experts in nursing education, nursing practice, governance and government as well as labour movements validated the tool. A total number of 10 experts participated in the validation process. Results: Themes and categories emerged from the qualitative design, which were later converged to guide the questionnaire used for the developed tool. This developed tool consists of five sections. Section A consists of six main competencies, 17 domains and 144 items, which were rated on a five-point Likert scale by community service nurses. The six main competencies are as follows: legal practice; ethics and professional practice; operational (unit) management and leadership; contextual clinical and technical competence; therapeutic environment; and quality nursing care. Sections B – E with semi-structured questions to be completed by the CSN; the peer and the mentor. To measure the tool’s reliability and validity, a content validity index (CVI), content validity ratio (CVR) using the experts’ validation and the Cronbach alpha was done using the SSPS version 25. 10 experts and 11 CSNs participated in this process respectively. This tool’s CVI has exceeded 0.80 as it is at 0.98, which shows excellent content validity. A higher CVR score indicates greater agreement among experts. The Cronbach’s alpha coefficients in the six (6) competencies are all greater than 0.7 and this implies that the tool used for this study was proven to be reliable during the pilot study. All experts and community service nurses indicated that the tool is clear, simple, general, accessible and important. Conclusion: The results of this research indicate that piloting the developed clinical competence evaluation tool demonstrates adequate reliability and validity for measuring the perceived clinical competence of the community service nurses. This tool was also deemed essential; useful and easy to administer despite the concern regarding the length raised by some experts and the tool was proven to be reliable. Limitations and further recommendations based on the research objectives are discussed.
- Health Sciences