Clinical competence

In order to prepare counselor-trainees to practice competently and maximize
client outcomes, counselor-trainees must develop a broader understanding and
explanation, called a case conceptualization, of their clients presenting problems,
personality, and systemic dynamics. There is a limited body of research that examines
the effects of training on the ability for counselors to develop an effective case
conceptualization. This is the first study to train counselors to develop competence in
formulating an integrative case conceptualization. This quasi-experimental study aimed
to determine whether an intervention had an effect on the 85 counselors in training that
participated in a 2-hour training. Data was analyzed using paired sample t-tests, an
independent t-test and correlation methods. Participants’ CCEF scores significantly
improved from the training (t = -25.970, df = 84, ES = 3.67, p < 0.001). Participants’
CFCCM scores significantly improved as well (t = -21.693, df = 84, ES = 2.78, p <
0.001). Participants’ scores also significantly improved with their perceptions about case conceptualization (t = -30.828, df =84, ES = 5.47 p < 0.001), for items 1-5. Item 6
resulted in values of (t = -13.295, df = 84, ES = 2.14, p < 0.001). The level of cognitive
complexity as measured by the CCQ did not have a significant effect on the quality of the counselors in training case conceptualizations. Compared to the CFCCM, the CCEF is a much shorter and easier instrument for evaluating a case conceptualization. Overall, results of this study provide support that counselors in training can improve their quality of case conceptualization skills in as little as 2 hours. This can aid in understanding and explaining their client’s situation better, which may significantly improve the treatment
process and client.

The purpose of this study was to determine the relationships between the nurses' decision making model, frequency of Rapid Response Team (RRT) activation, and the nurse's skill at the early recognition of clinical deterioration. A descriptive, cross sectional quantitative design was used. The participants in this study were 167 acute care registered nurses who had activated the RRT at least once in the preceding 12 months. The participants first were asked to recall a time when they had made the decision to activate the RRT and then were asked to complete the instruments used in this study. Using the Nurse Decision-Making Instrument, the participant's decision making model then was categorized as analytic, intuitive, or mixed. The skill at early recognition of clinical deterioration was measured with the Manifestations of Early Recognition Instrument. Participant scores on the two instruments were significantly correlated with each other as well as to their frequency of RRT activation over the preceding 12 months. The findings of this study indicated that nurses who used analytical decision making activated the RRT with greater frequency than either the intuitive or mixed decision makers. In addition, registered nurses who used analytical decision making to activate the RRT tended to have higher levels of skill in the early recognition of clinical deterioration, as measured by the MER, than either the intuitive or mixed decision makers. Another finding of this study was that RNs with higher levels of skill in the early recognition of clinical deterioration tended to activate the RRT more frequently than RNs with lower levels of this skill. The implications of this study are that the use of analytical decision making may result in more frequent activation of the RRT.

Within the current context of the healthcare environment, the charge nurse role has become very important for safety and positive outcomes. There is little known about the role from the perspective of the charge nurse. This qualitative descriptive exploratory study examined the experience of being a charge nurse in acute care practice, and describes how charge nurses live caring in their support of nurses and patients. Ray's (1989, 2006) theory of Bureaucratic Caring, Swanson's (2008) caring attributes and leadership, and Boykin and Schoenhofer's (2001) theory of Nursing as Caring provided the theoretical lenses through which study findings were viewed. Semi-structured interviews were conducted with 20 charge nurses in 4 acute care facilities. Eight themes emerged from an inductive analysis of the data describing the experience of being a charge nurse in acute care practice: Creating a Safety Net, Monitoring for Quality, Showing the Way, Completing the Puzzle, Managing the Flow, Mak ing a Difference, Putting Out Fires, and Keeping Patients Happy. Participants also were asked questions about how they provide support to staff nurses and patients. Themes that reflected how charge nurses live caring in their support of staff and patients were: Jumping in the Trenches, Nurturing Staff Growth, Offering Authentic Presence, and Looking after Nurses. Additionally, the researcher used methods of narrative inquiry to get the participants to share stories of how they lived caring in their support of nurses and patients. Recommendations included the need to elevate the visibility of the charge nurse role and its importance to the organization, and provide support for leadership development. Job descriptions and competencies for charge nurses must reflect the complexity of the environment.

Professional competence is expected of all nurses in practice. Although new nurses have met the competency requirement for practice legally, opinions vary among new nurses and nurse administrators as to whether new nurses are indeed competent to practice nursing. The purpose of this phenomenological research study was to learn what new nurses think about professional competence. The research question guiding this study was, "What is professional competence from the perspective of newly licensed registered nurses?"