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Qom Univ Med Sci J 2022, 16(1): 2-17 |
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Ghanbari-Afra L, Sharifi K. Clinical Competence and Its Related Factors in Iranian Nurses: A Systematic Review. Qom Univ Med Sci J 2022; 16 (1) :2-17
URL: http://journal.muq.ac.ir/article-1-3385-en.html
URL: http://journal.muq.ac.ir/article-1-3385-en.html
1- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran
2- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran ,sharifi81k@yahoo.com
2- Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran ,
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Introduction
Nurses make up the largest part of the healthcare providers. They have always faced the two-way challenges and concern of assuring the quality of provided care. For this reason, the quality of nursing care is always evaluated by the authorities to ensure that they have the capacity to provide an effective care. One of the factors that affects the quality of nursing care is clinical competence. Full clinical competence enables nurses to perform their duties with appropriate quality. Improving clinical competence can improve the quality of life, quality of nursing care, and nursing job satisfaction.
Many studies have been conducted on the clinical competence of nurses in Iran. Some studies have reported that the clinical competence of nurses is at a good and excellent level, while the findings of Karimi (2017) [15] showed that more than 60% of nurses had low clinical competence; after receiving training, the clinical competence of more than 90% of them reached moderate level. The results of Khodayarian (2011) [16] indicated that providing training has no effect on improving the clinical competence of nurses. Bahraini (2011) [17] reported that 17-30% of clinical skills are not used by nurses. The results of these studies can help take appropriate steps to improve the clinical competence of nurses, but due to the large number of studies in this area, readers may not be able to reach a general consensus. Therefore, conducting a review study can be effective in solving this problem. Since no review study have been conducted in this field so far, this study aims to review the results of studies on the clinical competence of Iranian nurses and the factors affecting it.
Method
This is a systematic review study conducted in March 2022 on studies examined the clinical competence of Iranian nurses and the related factors . A search was conducted by two independent researchers in Web of Science, MagIran, Irandoc, Scientific Information Database (SID), Scopus, Science Direct, Cochrane, Google Scholar, and PubMed databases using the keywords “nurses”, “Iran” and “clinical competency”.
In examining the relevance of articles, their titles and abstracts were reviewed. After confirming the eligibility of articles in terms of place of study, year of study and objective, their full texts were reviewed by one of the researchers. Cross-sectional articles, case studies, cohorts, and interventional studies on Iranian nurses were selected. The Critical Appraisal Skills Programme checklists were used to evaluate the quality of articles. The inclusion criteria were: being written in Persian or English, related objective, examining the clinical competence of nurses working in Iranian medical centers and the related factors, being published in valid research journals, available fulltext, and having high or moderate quality. The studies that had low quality score, those conducted on other treatment staff or on nursing students, Short reports, and letters to the editor were excluded. Initial search yielded 3757. After excluding duplicates, considering inclusion and exclusion criteria, 46 eligible articles were finally selected.
Results
Findings showed that in most studies, the clinical competence of nurses was at good and high level based on self-reports and at moderate level according to head nurses. The highest score of clinical competence was related to the management (12 studies) and ethical and legal activity (3 studies) and the lowest score was related to the quality assurance (10 studies) and teaching and training (3 studies). In seven clinical trials and quasi-experimental studies, the clinical competence of nurses improved after the intervention.
Age, gender, marital status, university, level of education, high total work experience, type of employment, ward, work shift, working hours, type of hospital, level of interest in the job, Grade Point Average, patient satisfaction, job satisfaction, received education, spiritual health, emotional intelligence, sympathy, assertiveness, rational and intuitive decision-making, transfer of experiences and Knowledge through storytelling, professional identity, spiritual intelligence, organizational commitment, head nurse’s clinical competence, need for dependency, power and success, and quality of work life were significantly associated with clinical competence. Clinical competence also had a significant negative relationship with the number of employees, occupational stress, burnout, and overt and covert anxiety.
Discussion
The clinical competence of nurses in Iran is favorable. Numerous factors such as demographic, occupational, educational, satisfaction-related, individual, organizational, motivational, and psychological factors affect the clinical competence of Iranian nurses. In addition, most of studies on clinical competence of Iranian nurses and the related factors are descriptive or analytical. Some of the strengths of this study are the evaluation of nurses and head nurses, the use of census sampling in almost half of reviewed studies, and assessing the determining factors for improving clinical competencies in clinical wards. The weaknesses of this study are the assessment of Iranian nurses only, removing qualitative studies, including observational studies, and different evaluation methods. Therefore, it is recommended to pay more attention to qualitative and experimental studies in further research, and design specific tools to determine the clinical competence of nurses. It is also recommended that committees for monitoring the clinical competence of nurses be established with the aim of promoting and updating clinical competence in hospitals.
Ethical Considerations
Compliance with ethical guidelines
The code of ethics IR.KAUMS.NUHEPM.REC.1100.008 was issued by the Research Vice-Chancellor of the Faculty of Nursing and Midwifery of Kashan University of Medical Sciences in letter No. 126/10/29/P dated 26/4/2021.
Funding
Vice Chancellor of Research and Technology of Kashan University of Medical Sciences has been the financial sponsor of this research.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
Thanks are given to all the authors whose articles were used for this research.
Nurses make up the largest part of the healthcare providers. They have always faced the two-way challenges and concern of assuring the quality of provided care. For this reason, the quality of nursing care is always evaluated by the authorities to ensure that they have the capacity to provide an effective care. One of the factors that affects the quality of nursing care is clinical competence. Full clinical competence enables nurses to perform their duties with appropriate quality. Improving clinical competence can improve the quality of life, quality of nursing care, and nursing job satisfaction.
Many studies have been conducted on the clinical competence of nurses in Iran. Some studies have reported that the clinical competence of nurses is at a good and excellent level, while the findings of Karimi (2017) [15] showed that more than 60% of nurses had low clinical competence; after receiving training, the clinical competence of more than 90% of them reached moderate level. The results of Khodayarian (2011) [16] indicated that providing training has no effect on improving the clinical competence of nurses. Bahraini (2011) [17] reported that 17-30% of clinical skills are not used by nurses. The results of these studies can help take appropriate steps to improve the clinical competence of nurses, but due to the large number of studies in this area, readers may not be able to reach a general consensus. Therefore, conducting a review study can be effective in solving this problem. Since no review study have been conducted in this field so far, this study aims to review the results of studies on the clinical competence of Iranian nurses and the factors affecting it.
Method
This is a systematic review study conducted in March 2022 on studies examined the clinical competence of Iranian nurses and the related factors . A search was conducted by two independent researchers in Web of Science, MagIran, Irandoc, Scientific Information Database (SID), Scopus, Science Direct, Cochrane, Google Scholar, and PubMed databases using the keywords “nurses”, “Iran” and “clinical competency”.
In examining the relevance of articles, their titles and abstracts were reviewed. After confirming the eligibility of articles in terms of place of study, year of study and objective, their full texts were reviewed by one of the researchers. Cross-sectional articles, case studies, cohorts, and interventional studies on Iranian nurses were selected. The Critical Appraisal Skills Programme checklists were used to evaluate the quality of articles. The inclusion criteria were: being written in Persian or English, related objective, examining the clinical competence of nurses working in Iranian medical centers and the related factors, being published in valid research journals, available fulltext, and having high or moderate quality. The studies that had low quality score, those conducted on other treatment staff or on nursing students, Short reports, and letters to the editor were excluded. Initial search yielded 3757. After excluding duplicates, considering inclusion and exclusion criteria, 46 eligible articles were finally selected.
Results
Findings showed that in most studies, the clinical competence of nurses was at good and high level based on self-reports and at moderate level according to head nurses. The highest score of clinical competence was related to the management (12 studies) and ethical and legal activity (3 studies) and the lowest score was related to the quality assurance (10 studies) and teaching and training (3 studies). In seven clinical trials and quasi-experimental studies, the clinical competence of nurses improved after the intervention.
Age, gender, marital status, university, level of education, high total work experience, type of employment, ward, work shift, working hours, type of hospital, level of interest in the job, Grade Point Average, patient satisfaction, job satisfaction, received education, spiritual health, emotional intelligence, sympathy, assertiveness, rational and intuitive decision-making, transfer of experiences and Knowledge through storytelling, professional identity, spiritual intelligence, organizational commitment, head nurse’s clinical competence, need for dependency, power and success, and quality of work life were significantly associated with clinical competence. Clinical competence also had a significant negative relationship with the number of employees, occupational stress, burnout, and overt and covert anxiety.
Discussion
The clinical competence of nurses in Iran is favorable. Numerous factors such as demographic, occupational, educational, satisfaction-related, individual, organizational, motivational, and psychological factors affect the clinical competence of Iranian nurses. In addition, most of studies on clinical competence of Iranian nurses and the related factors are descriptive or analytical. Some of the strengths of this study are the evaluation of nurses and head nurses, the use of census sampling in almost half of reviewed studies, and assessing the determining factors for improving clinical competencies in clinical wards. The weaknesses of this study are the assessment of Iranian nurses only, removing qualitative studies, including observational studies, and different evaluation methods. Therefore, it is recommended to pay more attention to qualitative and experimental studies in further research, and design specific tools to determine the clinical competence of nurses. It is also recommended that committees for monitoring the clinical competence of nurses be established with the aim of promoting and updating clinical competence in hospitals.
Ethical Considerations
Compliance with ethical guidelines
The code of ethics IR.KAUMS.NUHEPM.REC.1100.008 was issued by the Research Vice-Chancellor of the Faculty of Nursing and Midwifery of Kashan University of Medical Sciences in letter No. 126/10/29/P dated 26/4/2021.
Funding
Vice Chancellor of Research and Technology of Kashan University of Medical Sciences has been the financial sponsor of this research.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
Thanks are given to all the authors whose articles were used for this research.
Type of Study: Review Article |
Subject:
پرستاری-جراحی-ویژه-کودکان
Received: 2022/01/29 | Accepted: 2022/05/9 | Published: 2022/04/30
Received: 2022/01/29 | Accepted: 2022/05/9 | Published: 2022/04/30
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