Nurses in paediatric care : competence, professional identity and research utilization

Paediatric health care is becoming highly specialized and there is a need of nurses with specialist knowledge in the field. A large turnover of personnel and shortage of specially trained paediatric nurses have resulted in employing newly graduated and inexperienced nurses which further contributes to a decrease in professional competence. Development of professional competence is thus a process that has to be present at all times and must be evaluated continuously. The aim of this thesis was to identify how competence levels can be shown by describing and analyzing how nurses employed in paediatric care describe their nursing role and how they evaluate their professional level and attitudes to research utilization. Furthermore, we wanted to analyze qualitative differences between nurses with diverse formal education and experiences. Study I: When eighteen newly graduated and newly employed nurses described what they included in the concepts of responsibility, management of daily and rapidly changing situations and reflection, the results, analysed with qualitative content analysis, showed that nurses seemed to be fully aware of their responsibility regarding patients' well-being. The moral responsibilities, i.e. to act as the patient's 'advocate' and protect patient's personal integrity, was also evident. The nurses emphasized the need of time and space for reflection, but also time to acquire the necessary knowledge for providing optimal nursing. Study II: Fifty-six newly graduated and newly employed nurses at two children's hospitals responded in written form to the two questionnaires; Professional Self Description Form (PSDF) 21 items in total including empathy, flexibility, ability to act etc.), and Barriers Scale 29 items in total concerning perceived barriers to research utilization). The results showed that in PSDF the nurses scored highest in compassion, ambition and sensitivity. The lowest scores were found in preparedness to act and problem-solving ability, leadership and discriminating capacity. In the Barriers Scale the nurses perceived the lowest barriers in the affirmations pertaining to themselves as nurses and the highest barriers within the areas concerning the organization. Study III: We have compared newly graduated nurses who had received 'traditional' introductory training and had worked for two years at a children's hospital (Controls, n=36) with nurses going through a one year trainee programme (Trainees, n=42) and with paediatric nurses with specialist education (Specialists, n=35), using the same questionnaire as in study II. The results showed that the control nurses rated themselves higher in the PSDF description of persistence compared to the other two groups. No other differences were found. In the Barriers Scale the specialists scored higher barrier in the affirmations pertaining to themselves as nurses, especially in that the nurse is unwilling to test new ideas, that there are not enough experienced colleagues with whom to discuss research results, and that the administration does not allow implementation of research results. Study IV: When comparing nurses with diverse formal education and experiences concerning qualitative differences when reasoning about a paediatric case the results showed some disparities. The study was based on six recorded group discussions of a fictive but realistic paediatric case and was analysed by a qualitative latent content analysis. Out of the themes found: child's social situation, child abuse and the child's illness, qualitative differences emerged in how the nurses discussed the case. Three separate approaches were identified: a task-oriented, an action-oriented and a hypothesis-oriented, the latter being evident in the two groups comprised of nurses with specialist education. Between the two other groups, novice and experienced nurses, no differences were shown in how they discussed the case. In conclusion: Newly graduated nurses are aware of their responsibility as nurses in general. Self-evaluation of 'professional self' and barriers to research utilization are quite similar and independent of professional experience and knowledge. Nurses with long experience and specialist education have a different approach in how they discuss a fictive but realistic case compared to nurses with lower educational level. Thus, the importance of experience per se for the development of competence is still an open question. Working experience in combination with further, specialist education seems to be of importance in the development of professional competence in paediatric care