Development of a Performance-Based Clinical Competence Tool for Hospital Nurses in Taiwan

Purpose: Clinical competence is important in patient safety and proving quality care. Cultivate nurses’ competence becomes a main issue. The purpose of the study was to develop a performance-based competence tool to both increase and evaluate nurses’ clinical competence. Additionally, nurses’ perceived competence was measured and the top skills that were unconfident performing were explored as well.

Methods: The study was a pretest-posttest descriptive design with convenience sampling. Sixty nurses were recruited from three hospitals in Taiwan. The mean age and work experience of the participants was 28.65 and 7.2 years, respectively. 39.79% of them were in their first employment year. 93.33% had a bachelor degree. 40% worked in teaching hospitals and 90% worked in medical-surgical related units. The Clinical Competence Scale (CCS) developed by the authors was used to evaluate perceived competence. The Cronbach's alpha for the CCS was .81. The content, construct, and concurrent validity of the CCS were supported in the study. Nurses were asked to fill out the CCS before and after they finished the performance-based competence tool. Descriptive statistics and paired t test were applied to analyze data.

Results: The performance-based competence tool consisting six case-based scenarios was developed based on eight steps of clinical reasoning proposed in the Clinical Reasoning Model. The developed performance-based competence tool was intended to train nurses’ clinical reasoning/critical thinking abilities and examine their performance-based competence. In each scenario, sub-situations with questions, which are sequenced and focus on clinical reasoning/critical thinking abilities, were developed to reflect a patient’s changing condition or deterioration. The total score of all scenarios are 510. This tool is designed with a scoring system that nurses can understand their own performance in clinical situational care and they can train clinical reasoning/critical thinking abilities by repeatedly taking the program. The mean score of the CCS decreased significantly from pretest (M=3.55 on a 5-point Likert scale) to posttest (M=3.35, t=2.91, p<.01). The mean score of the performance-based competence tool was 317.76 which was under the requirement score 336 (reaching 70% of the total score is a satisfaction level). The top five unconfident clinical skills of performing for nurses were reading EKG, performing CPR, venipuncture, and performing blood transfusion.

Conclusion: Nurses’ posttest score of perceived clinical competence, which was taken immediately after finishing the performance-based competence tool, was significantly lower than the pretest score. This result implied that nurses over-estimated their actual performance abilities in the real world. After completing the developed tool, nurses can understand what their lack is in performing competent patient care and therefore can increase their knowledge or skills. Nurse administrators are suggested to train nurses on those skills that nurses are not unconfident performing. Further research in understanding nurses’ weakness of abilities is needed to provide information for nursing administrators to design appropriate continuing education/training for nurses.