Effectiveness of Pre – Clinical Competency Certification Program on Improving Knowledge of Clinical Practice Among Nursing Internship Students

Gethsial Kiruba1, A. Rebecca2

1Executive – Quality and Training, Kauvery Hospital, Chennai, India

2Associate Professor, KMC College of Nursing, Trichy, India

Abstract

Background: Nursing competencies are core abilities that a nurse must have to fulfill her role. This is basic to nursing and a significant parameter for freshmen nurses’ job readiness to begin their career in health care. A study was conducted to assess the level of clinical competency among nursing students and to assess the effectiveness of Pre-Clinical competency certification program among nursing students.

Methods: A sample of 84 nursing interns was selected using purposive sampling over a period of 3 months. After pretest & orientation, participants were subjected to 30 hours of didactic, experiential and objective structured practical learning (OSPL) with 15 modules designed as PCCP. For the subsequent 3 months, participants were exposed to one reinforcement session & two OSPL with 15 skill stations blended with self-learning hand-outs. Data were analyzed to define the level of knowledge on clinical practice.

Conclusion: The study showed that there was an increase in the mean knowledge score with a significant level of P <0.001 and hence the study hypothesis was accepted. The PCCP was found to have immediate effect on nursing interns’ competency increasing their job readiness level before and after internship.

Keywords: Pre-Clinical Competency Certification Program, Interns, Clinical Practice, Objective Structured Practical Learning, Clinical Competency, Experiential

Background Nursing competencies are core abilities that a nurse must have to fulfill her role. These are basic to nursing and are significant parameters for freshmen nurses’ job readiness to begin their career in health care. Competency is a cluster of knowledge, skills and attitudes. It is the core of nursing which involves rational performance, and can improve with training and development [1,2].

Clinical learning is a key factor that enables student nurses to perform effectively by applying theoretical and practical knowledge. It also helps them to develop their professional identity by applying the skills they learned to the clinical setting where they are working.

Despite this, the gap between the theory and practice is clearly seen on the floors of hospitals which has caused concern to educators, practitioners and also to the students. With this in view, in order to match the inconsistency between the theoretical classroom lectures and real-life experience in the clinical setting, the investigators planned for a three days learning program and named it as PCCP [3].

This PCCP (Pre-clinical Competency Certification Program) is structured and specifically designed considering the clinical context in which the freshmen nurse will find herself as a staff in the hospital.

A pre-experimental study to assess the effectiveness of pre-clinical competency certification program on improving knowledge of clinical practice among nursing internship students at selected colleges in Trichy.

The aim of this study to assess the level of clinical competency among nursing students and to assess the effectiveness of pre-clinical competency certification program among nursing students [4].

Methods

A sample of 84 nursing interns who are at internship training was selected, using purposive sampling technique, from KMC College of Nursing Trichy and Mount Zion College of Nursing, Pudukkottai. They were subjected to one group pretest – posttest design over a period of three months in the year 2018. Ethical clearance and participant consent were obtained. After pretest and orientation, participants were subjected to 30 h of didactic, experiential and objective structured practical learning (OSPL) of PCCP. The subsequent three months participants were exposed to one reinforcement interactive session and two OSPL with 15 skill stations blended with self-learning hand-outs. The research tool consisted of Competency Assessment questionnaire with 25 items. Each correct answer was scored as ‘1’ and if the answer is wrong ‘0’ mark was awarded.

Pre-clinical Competency Certification Program (PCCP)

It is a certification program designed for nursing students to improve their knowledge from cognition to behavior level of clinical learning and development (Fig. 1), with 15 basic modules. This certification program was conducted for three days with two days interactive lecture sessions (Fig. 2) and the third day the students were engaged with Objective Structured Practical Learning (Fig. 3) with 15 Work stations of competencies and skills. They were rotated in turns for each station for the demonstration and re-demonstration of each.

  1. KMC/PCCP/NUR/001 – Patient Care Basics
  2. KMC/PCCP/NUR/002 – Hospital Infection Control – Patient Care, Biomedical Waste and Staff Safety
  3. KMC/PCCP/NUR/003 – Drug Calculation & Medication Management Module
  4. KMC/PCCP/NUR/004 – Nursing Empowerment, Problem solving & Adaptability
  5. KMC/PCCP/NUR/005 – Communication for Bed Side Nurses, Attitudinal & Behavioral Workplace Skills
  6. KMC/PCCP/NUR/006 – Leadership skills for Bedside Nurse
  7. KMC/PCCP/NUR/007 – Balancing Patient satisfaction and Nurses satisfaction
  8. KMC/PCCP/NUR/008 – Patient & Staff Safety
  9. KMC/PCCP/NUR/009 – Pain Management & Palliative care (EOL)
  10. KMC/PCCP/NUR/010 – Advanced Nursing Practice & Technology
  11. KMC/PCCP/NUR/011 – Triaging, First aid and Basic Trauma Support
  12. KMC/PCCP/NUR/012 – Basic Life Support & ECG Interpretation
  13. KMC/PCCP/NUR/013 – Diabetic Patient Care & Diabetic Education
  14. KMC/PCCP/NUR/014 – Tissue Viability & Wound care Nursing
  15. KMC/PCCP/NUR/015 – Proactive and Predictive role of the Clinical Team
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Fig. 1. Inauguration and the team of faculty from all units.

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Fig. 2. Classroom lecture and felicitating the speakers.

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Fig. 3. Objective Structured Practical Learning.

Results

The Pretest and the post test score of the students were analyzed using descriptive analysis to define the level of knowledge on clinical practice. It was seen that 53% of the nursing students had inadequate knowledge and 47% of them had moderately adequate knowledge before Pre-Clinical competency certification program. The posttest score indicated that 3% of the nursing students had moderately adequate knowledge, 97% of them had adequate knowledge and none of them had inadequate knowledge (Fig. 4) and hence the study hypothesis which states that there will be a significant increase in the competency of nursing immediately after PCCP was accepted.

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Fig. 4. Level of Knowledge among nursing students regarding clinical practice.

Table 1: Effectiveness of PCCP regarding knowledge of clinical practice

Test Mean SD z-value p-value
Pretest 8.44 2.40 45 < 0.001
Postest 22 1.73

The effectiveness of PCCP among nursing students under internship training was analyzed using “z” test. There was an increase in the mean knowledge scores from 8.44 to 22 with a significant level of p < 0.001 after the intervention (Table 1). Hence the study hypothesis which states that there will be a significant difference between the mean pre and post test knowledge scores among nursing students was accepted.

Conclusion:

The PCCP was found to have immediate effect on nursing interns’ competency. The pre clinical competency certification program was an effective strategy to help the final year nursing students who are under internship training to equip themselves with adequate knowledge regarding clinical practice. This would in turn help the hiring institutions to directly recruit them as they are well aware of all the current practices. This would also come handy in utilizing their skills in crisis situations like increase in bed occupancy, shortage of staff nurses, overtime work for nurses etc. The success of the program is that we have done this for three years continuously before we were confronted with the COVID pandemic.

Acknowledgement

A special thanks to Dr. Jothi Clara J Michael, former Chief Clinical Governance Officer for initiating this programme and to build a bridge between the clinical team and the nursing students and make us write this paper for publications as well in editing it. The success of the program is that we have done this for three years continuously before we were confronted with the COVID pandemic.

References:

  1. Barton G, Bruce A, Schreiber R. Teaching nurses teamwork: Integrative review of competency-based team training in nursing education. Nurse Education in Practice. 2018;32:129–137.
  2. Cronenwett L, Sherwood G, Pohl J, Barnsteiner J, Moore S, Sullivan D. et al. Quality and safety education for advanced nursing practice. Nursing Outlook. 2009;57(6):338–348.
  3. Curley MAQ. Patient-nurse synergy: optimizing patients’ outcomes. Am J Crit Care. 1998;7(1):64–72.
  4. Reynolds S, McLennon S, Ebright P, Murray L, Bakas T. Program evaluation of neuroscience competency programs to implement evidence-based practices. J Evalu Clin Pract. 2016;23(1):149–155.-7

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