Expected competencies of Iranian undergraduate nursing students: an exploratory sequential mixed study

Abstract

Abstract Background: Nursing competencies are vital indicators of quality and safe care. Newly graduated nurses are now recognized as a professional group that will influence the health of future populations. The ever-increasing demand for quality and safe nursing practice has caused many nursing curricula to fail to respond to the changing needs of society. This demand has increased with the advent of new educational technologies and the gap between theory and clinical practice. In addition, there are concerns about the lack of preparation of students to enter the clinical setting, which may reduce the quality of care and endanger patient safety. In Iran, the lack of competencies expected of students, in addition to the lack of clear definition of core competencies in the semester levels of the Iranian nursing curriculum, has resulted in nursing students not having the necessary competencies to achieve standards of care. Therefore, this study was conducted with the aim of "determining the expected competencies of Iranian undergraduate nursing students". Methods: The present study is an exploratory sequential mixed methods study and consists of three stages: in the first stage, we identified the competencies expected of undergraduate nursing students in Iran and worldwide. The present study is an Exploratory Sequential Mixed Methods Study and consists of three stages: in the first stage, we identified the competencies expected of undergraduate nursing students in Iran and worldwide. We conducted a scoping review using the methodology recommended by the Joanna Briggs Institute (JBI) supported by the PAGER Framework and guided by the PRISMA-ScR checklist, and to ensure the quality and methodological accuracy of the selected articles, the mixed method appraisal was used, To analyze and describe the summative content analysis proposed by Hsieh and Shannon (2005) was used, which includes: counting keywords may identify patterns, frequencies and distributions, and can provide the contextual use of keywords. In the second step, the items of the instrument were created based on the results of the first step. The validity of the instrument was then tested with face validity, content validity (determining the ratio and index of content validity), and validity of known groups. Convergent validity and reliability were also checked by internal consistency and stability by the test-retest method. In the third stage, in a parallel study with a comparative descriptive design, 721 final-year nursing students and 365 nursing teachers were selected from 208 active nursing schools (including; 114 Public state universities and 94 Private Universities) from 31 Provinces by conventional sampling. An electronic method was used to collect data from both groups through the porsline platform for students and email for teachers. An Independent t-test was used to analyze the descriptive data of frequency and percentage, mean and standard deviation for quantitative variables, and to calculate the mean difference between the levels of competencies in the PRISMA-ScR checklist, and to ensure the quality and methodological accuracy of the selected articles, the mixed method appraisal was used, To analyze and describe the summative content analysis proposed by Hsieh and Shannon (2005) was used, which includes: counting keywords may identify patterns, frequencies and distributions, and can provide the contextual use of keywords. In the second step, the items of the instrument were created based on the results of the first step. The validity of the instrument was then tested with face validity, content validity (determining the ratio and index of content validity), and validity of known groups. Convergent validity and reliability were also checked by internal consistency and stability by the test-retest method. In the third stage, in a parallel study with a comparative descriptive design, 721 final-year nursing students and 365 nursing teachers were selected from 208 active nursing schools (including; 114 Public state Universities and 94 Private Universities) from 31 Provinces by conventional sampling. An electronic method was used to collect data from both groups through the porsline platform forstudents and email for teachers. An Independent t-test was used to analyze the descriptive data of frequency and percentage, mean and standard deviation for quantitative variables, and to calculate the mean difference between the levels of competencies in the groups. Findings: From a total of 15875 English articles and 1887 Persian articles, 48 articles (including; 43 foreign articles and 5 Iranian articles) were selected. The analysis of the data in the qualitative section led to the identification of 17 competencies in 5 themes, including; "Individualization Care (4 subthemes including; Cultural Humility 2 items, Values and Ethical Codes 11 items, Holism 1 item, and Therapeutic Communication & Participatory Decision Making 7 items)", "EvidenceBased Nursing Care" (2 subthemes including; Knowledge Acquisition 4 items, and Critical Appraisal and Evidence 6 items), 'Professional Nursing PRocess' (3 sub-themes including; General Critical Thinking (Problem-Solving) 1 item, Specific Critical Thinking (Reasoning, Judgment and Clinical Decision Making) 2 items, and Professional Critical Thinking/Application of the Nursing Process 10 items), 'Nursing Management' (2 sub-themes including; Management and Leadership 13 items, and Informatics and Documentation 3 items) and 'Work Readiness and Professional Development' (6 sub-themes including; Personal Characteristics 7 items, Legality 2 items, Clinical/Procedural Skills 2 items, Safety 4 items, Preventive Health Services 3 items and Mentoring competence 5 items) as competencies expected of a student about to graduate. The first draft was prepared with 117 items and after the psychometric process, the final instrument with 85 items entered the third stage of leveling. The comparison of expected and achieved core competencies from the perspective of teachers and nursing students showed that it was significant at the level of (P <0.01) in all 5 themes. However, among these 5 themes, Evidence-Based Nursing Care had the highest mean difference (mean diff=1). Conclusion: The results of the study in the quantitative stage also showed that both in the group of nursing teachers and students, the highest level of expected and achieved competencies related to the two competencies of Work Readiness and Professional Development, Nursing Management, and the lowest level of expected and achieved competencies related to the two competencies of Professional Nursing Process and Evidence-Based Nursing Care. Therefore, it can be concluded that the agreement of the findings of the quantitative phase with the findings of the qualitative phase has confirmed the generalizability and validity of the findings of the study and the importance of these competencies and the success rate of higher nursing education institutions in bringing students to the expected level of competence. Furthermore, it can be concluded that the researchers in this study were able to use the inherent strengths of each of the qualitative and quantitative research methods to overcome the weaknesses and shortcomings of the other to provide an accurate, valid, and reliable answer to the research question. This study also showed the gap between the teachers' expectations and the achieved competencies of the nursing students in all competency themes.