Nursing Older People - Competence Evaluation Tool. Development and psychometric evaluation of an instrument measuring community-based nursing staff competence

Abstract

This study aims to contribute to the assessment of quality of municipal elderly care by developing an instrument for measuring nursing staff competence. Competence measurements are well known and frequently used within nursing education and practice but less common in municipal elderly care, and they have not been conducted in Norwegian municipal elderly care. Improving the competence of employed staff is at the essence of quality improvement processes, and quality of care requires that all staff members have sufficient competence to provide safe care to patients. Competence is understood as a contextual, multi-faceted concept consisting of knowledge, skills and personal attributes. The individual competence of a practitioner is seen as inherently bound to the competence of other practitioners.

The purpose of this study was to develop and evaluate a competence measurement instrument for nursing staff working in nursing homes and home care services. The aims were achieved through three sub-studies: (1) A systematic literature review and evaluation of instruments measuring the competence of nursing staff in community health care, (2) Identification of the competence necessary to provide safe services to older people in Norwegian municipal elderly care, and (3) Questionnaire development, testing, and comprehensive evaluation.

The finding in Sub-study 1 was All instruments reviewed employed self-assessment as the main source of information. Self-assessment is found to be less valid in groups with low competence compared to groups with higher competence, and should therefore be supplemented with other methods for assessing competence, like testing. Although some instruments were evaluated for reliability and validity, all instruments reviewed fell short in terms of comprehensive instrument evaluation.

In Sub-study 2, the most relevant content of the new competence measurement instrument was found to be covered in 62 items within ten categories: health promotion and disease prevention, treatment, palliative care, ethics and regulation, assessment and taking action, covering basic needs, communication and documentation, responsibility and activeness, cooperation, and attitudes toward older people. Some competence items concerning advanced practices among nurses did not reach consensus, which conflicts with competence expected in government policy documents. The Nursing Older People - Competence Evaluation Tool (NOP-CET) was developed based on the items that reached consensus in Sub-study 2, and consists of a total of 346 questionnaire items. The NOP-CET measures the competence of registered nurses, assistant nurses, and assistants working with older patients in nursing homes and/or home care services. The questionnaire contains items of self-assessment and test-items, and employs seven different response formats.

In Sub-study 3, the NOP-CET was tested on 1016 nursing staff in ten municipalities. The NOP-CET was evaluated and found appropriate for its purpose of measuring communitybased nursing staff competence. The NOP-CET was found to have good content validity and reliability, and acceptable construct validity. Precision was acceptable considering the wide range of competence – from registered nurses to assistants – that the NOP-CET measures. The scores of the NOP-CET are easily interpretable when reported either item-by-item or in sum-scores. The instrument, which was considered acceptable for RNs and ANs, can be improved for assistants. Filling out the NOP-CET was found feasible for the municipalities taking part in the first survey.

This study contributes three aspects to the field of nursing practice, education and research. The first is a framework outlining what competence in municipal elderly care should consist of. Municipalities can use this framework to evaluate available competence and plan the competence to acquire in the future. The framework can be used when evaluating current education of nurses, and as a basis for international studies examining competence in community elderly care. The second contribution of this study is the new competence measurement instrument. The NOP-CET can be used to explore the competence of nursing staff employed in nursing homes, home care services, or entire municipalities. Finally, to decrease measurement error, this study advocates comprehensive instrument development procedures and instrument evaluation within nursing as a science.