| ObjectiveNurse Core Competency is the prior part of nursing education and the most important capability to be armed by professional nurse. As an instrument to help developing nursing profession, Nurse Core Competency offers guidance for nursing staff to give full wings to their professional knowledge, thus enhancing performance and efficiency of clinical nursing. The growth of nursing profession since21st century and the nursing service campaign promoted by the National Sanitary Department have raised higher requirements for Nurse Core Competency. ICU, as a medical working environment, is unique with its modern and first-aid monitoring facilities. The patients in ICU are often in critical condition and instable state. These require ICU nurses to be with higher professional skills. However, traditional methods applied in the cultivation of Nurse Core Competency concentrate on the passive impartation of knowledge, such as Lesson on A Special Topic, One to One Teaching, and Case Study etc., which neglect the activeness and coordinating ability of learning and fail to reach teaching expectation. Therefore, something must be done to improve traditional methods and explore new ones in the cultivation of Nurse Core Competency. More and more educators and administrators in the nursing field have recognized this problem and started to make commitment to seek for more effective methods to cultivate Nurse Core Competency.The concept of PAL (Peer-Assisted Learning) was first put forward by Professor Topping from Britain and Dr. Ehly from the USA. PAL refers to a series of learning activities to gain knowledge and skills through the help and assistance actively offered by another person with similar study status or background (the peer). As a new teaching and learning strategy, PAL has achieved abundant experimental success throughout the world, and is widely applied in education field. Since the General Medical Council claimed in 《Tomorrow’s Doctors)) that students specializing in medical science should possess measurable teaching skills, PAL has been more and more valued and applied, but the application of PAL in the clinic nursing education is still inadequate and in the core competency has not be reported.Based on the demand for cultivation of Nurse Core Competency in ICU and the application status of PAL, this research aims to analyze the function of PAL in the cultivation of Nurse Core Competency in ICU, by combining PAL method together with traditional method.MethodsObjects of the research were the ICU nurses working in a polyclinic in Shenzhen. The nurses in the east and west unit were respectively set as intervention group and control group. Each group had30people who have passed the ICU access training and assessment, excluding rotation staff, staff in further study and staff having less than1year working experience in ICU.1. Comparison of general information of the research objectCompare sex, professional title, education level, age, the time in ICU and core competency of nurses between2groups before training.2. Measures taken in the Cultivation of Nurse Core Competency in ICU With reference to related materials and books, we set up the ICU Nurse Core Competency training schedule and allocated related knowledge and skill training classes. Throughout January to December2011, the two groups of nurses were taught according to the same training schedule, with the same classes and by the same teachers.The nurses in control group were trained by traditional method. Specifically, theoretical lessons were imparted through multi-media software. Review homework was arranged at the end of the class. For nursing operation classes, teachers would demonstrate on stage first, and then nurses would do the operation one time with teacher’s instruction. After class, nurses practiced the operation process and further studied on their own.However, in intervention group, apart from traditional training measures, PAL was applied as a fortifier. To be more particular, firstly, members chose another member as their learning partner, to make up the two-person peer-assisted team. Secondly, they needed to set up and carry out a learning plan together. Every month, they reviewed and advised each other on the process of the learning plan. Thirdly, the members were arranged in the same shift as far as possible, so that they could share and discuss with each other the difficulties, confusion and experience they underwent during clinical nursing in their free time. Fourthly, a2-3hour group discussion meeting was held once a month by the training teacher, where each peer-assisted team was obliged to raise at least1-2difficult points they came across during the training as topics to be discussed. The aim of the discussion meeting was to help solve the problems through collecting idea from different members of the whole group.3. Methods of Evaluating Nurse Core Competency in ICUAfter the one-year training project, both subjective evaluation and objective evaluation would be employed to review the Core Competency of the two groups of nurses.3.1Objective EvaluationTest papers were made based on the content of the training project. Assessments on nurses’theoretical knowledge and operational ability were held each season and when the training project was over, an overall assessment was done by totaling and then averaging all results of theoretical and operational tests. This type of evaluation was to just compare the averaged results of two groups, and is strict and just, revealing nurses’actual results and abilities.3.2Subjective EvaluationThe basis of subjective evaluation is the gauge "Competency Inventory for Registered Nurse, CIRN" edited by Professor Liu Ming, which is used for ICU nurses to do self assessment on their own Core Competency. CIRN was developed in2005as a self evaluation form for nurses’all-round Core Competency assessment. As the first gauge edited theoretically based on the Competency Composition for Registered Nurse, CIRN covers7dimensions and58items, including critical thinking/scientific research (10items), clinical nursing (9items), leadership (10items), interpersonal relationship (8items), law/ethics practice (8items), professional development (6items) and education/enquiry (7items). The Likert’s5Scale Format was used as the calculating method (0-none capability,1-weak capability,2-moderate capability,3-good capability,4-excellent capability). The range of the total result runs from0to232. The higher the result is, the better is the Core Competency. The form has been examined by considerable measurement characteristics, and is of high validity and reliability. Cronbach’s a value for reliability of the whole form is0.89, of the7dimensions is0.79-0.86, and r value for the validity of the proofread of the form is0.44. Before the evaluation began, an instruction meeting was held to ensure nurses’ thorough understanding of the questionnaire, facilitating the objectiveness and validity of the evaluation.4. Statistics MethodAfter collecting data from objective test papers and subjective questionnaires on ICU Nurse Core Competency, SPSS11.5was used to analysis it. The self differences of measurement data were compared with paired t-test. The group differences of measurement data were compared with independent sample t-test and analysis of covariance. The enumeration data were compared with χ2test. Then the results clearly displayed the difference in the effects between2groups after applying different training methods.5. Issues to pay attention to during the implementation of PAL(1)Blind method should be applied in delivering and collecting test papers and questionnaires to avoid bias.(2)During the research, researcher should monitor and facilitate the process by coordinating the relationship between and in the groups.(3)Members in intervention group should take the same shift so as to make full use of work time to discuss and solve study problems.(4)The monthly discussion meeting would take up some of the leisure time of the nurses, but the researcher should try to win the active co-operation from nurses by convincing the leaders of the hospital to returning the leisure time to nurses as compensation.Results1.Both2groups finished the training project, and both traditional training program and PAL training program were successfully launched. All of the tests and assessments were smoothly accomplished at different stages of the training project.60CIRN questionnaire forms were delivered before and after the training respectively and60were returned, return rate100%. With all questionnaires being valid, validity was100%.2. The differences of sex, professional title, education level, age and the time in ICU of nurses between2groups were no statistical significant, the value of χ2or t was0.1307、0.3640、0.1179、0.492、0.040and the value of P was0.7177、0.9476、0.9427、0.625、0.969respectively. The differences in Nurse Core Competency of ICU were also no statistical significant.3. Nurses in intervention group and control group achieved to get higher results in theoretical tests, operational tests and self assessment after training. The value of t in intervention group were8.963,10.756and16.031, the value of P were all0.000. The value of t in control group were4.179,3.943and9.229, the value of P were all0.000. The self differences were statistically significant.4. The scores of both theoretical test and operation test in intervention group were higher than those in control group. The nurses in intervention group got test scores with86.17±4.11in theoretical test and90.77±3.90in operation test, while those in control group got80.27±4.09and85.40±4.56respectively, the value of t were5.570and4.898, the value of P were both0.000, the differences were statistically significant. The test scores before training were regarded as covariate in analysis of covariance to compare the difference between2groups after training. The value of F were32.012and23.575, the value of P were both0.000. The differences were statistically significant.5. The self assessment scores of intervention group in Core Competency were higher than those of control group. The total score got by the nurses in intervention group was186.73±15.39, while159.23±16.34in control group, the value of t was6.709, P was0.000. To take a closer look to every dimension respectively, The intervention group got score with33.80±2.70in critical thinking/scientific research,30.17±2.35in clinical nursing,28.57±3.54in leadership,25.47±2.97in interpersonal relationship,25.53±2.83in law/ethics practice,20.53±1.25in professional development and22.67±1.67in education/enquiry, while the control group got27.13±3.62,25.63±2.53,21.77±3.76,22.97±1.77,23.43±1.85,18.67±1.67and19.63±2.50respectively. The values oft were8.094.7.198.7.215,3.962,3.405.4.902,5.531, the values of P were0.000、0.000、0.000、0.000、0.001、0.000、0.000respectively. The differences all were statistically significant. The self assessment scores before training were regarded as covariate in analysis of covariance to compare the differences between2groups after training. The value of F on self assessment total score was44.572, the value of P was0.000. The values of F on every dimension score were68.296、53.531、52.997、16.136、10.786、23.662、30.106,the value of P were0.000、0.000、0.000、0.000、0.002、0.000、0.000. The differences were all statistically significant.Conclusions1. Nurse Core Competency has been improved through both the traditional training program and the PAL training program, which demonstrates that Nurse Core Competency can be improved by applying any training method. Nursing manager and educator should make full use of available resource to cultivate Nurse Core Competency in order to improve nursing quality.2. PAL itself has overcome the one-way imparting of message in traditional training, enhances nurses’learning activeness through debating, and provides chances to consolidate their absorption of knowledge through discussion meeting, thus improving theories test scores. PAL changes theory into practice through the peers’ interactive activity to realize the improvement of operation test scores.3. PAL facilitates the cooperation and trust between peers, helps nurses to clarify their purpose in studying, and upgrades nurses’judgmental ability and confidence. Apart from that, PAL improves nurses’interpersonal ability and performance in other aspects such as critical thinking, clinical nursing, leadership, interpersonal, law/ethics practice, professional development and education/enquiry etc.All in all, experiments have proved that PAL plays as a fortifier in the cultivation of Nurse Core Competency in addition to traditional training methods; helps improve the effects in the cultivation of ICU Nurse Core Competency. PAL may be applied extensively in the field of clinical nursing training. |
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