Capstone Project on "Saudi Nursing Interns' Perceptions of Clinical Competence"

Capstone Project 37 pages (12676 words) Sources: 1+

[EXCERPT] . . . .

If there were enough local nurses that could support the development of undergraduates and new graduates, then the impact of multinational nursing workforces providing preceptorship programs to local undergraduate nursing interns would be minimized.

Undergraduate Nursing Internship at KFMC

King Fahad Medical City (KFMC) is considered one of the largest health care facilities in the Gulf region and consists of four hospitals (Main, Maternity, Pediatric, and Rehabilitation hospitals) making up a total of 1,095 beds. In addition to the hospitals there are primary care clinics, Faculty of Medicine Medical Centers that includes Prince Salman Heart Center, Neuroscience Center, Prince Sultan Hematology and Oncology Center and the Specialized Diabetes and Endocrine Center. Contributing to the Kingdom's goal of Saudization of the workforce, King Fahad Medical City in collaboration with King Saud University (KSU) which is one of the leading universities in the Gulf region and is highly respected in Arab and Muslim countries developed a very comprehensive nursing internship program (KSU, 2013).

The undergraduate nursing internship program at KFMC is designed to provide the novice Saudi nurse with the knowledge base and skill set needed to transition to competence in clinical nursing practice. While providing the needed skills to meet the organization's goals and mission, the program provides nurses with the leadership skills to work collaboratively within a multidisciplinary team. The program bridges the gap between undergraduate education and "real-life" professional nursing practice, with the desired outcome being nurses delivering state-of -- the art care. During the internship period, the undergraduate nursing interns are provided with a pathway to clinical comfort, confidence, and competency, leading to active participation as a member of a clinical team. Through varied clinical opportunities in general and specialized areas they gain insight into the diversity of patient care needs and the chance to focus on a particular area in nursing leading to future specialization.

The clinical instructor, preceptor, head nurse, and the nurse Educator of the Internship continually assess the undergraduate nursing interns (KFMC Nursing Internship Program, 2013). The KFMC internship program is designed so that the interns will have opportunity to rotate through the hospital and is divided into four phases. The first phase of the program consists of 1) a two -week new internship general orientation (NIGO) followed by 2) phase II consisting of a 20-week medical and surgical rotation followed by 3) another 20-week rotation in a specialty clinical area such as critical care or emergency department and 4) finally a 10-week elective rotation where the interns selects their preferred clinical area.

Purpose of the Study

The purpose of this study is to test Benner's (1982) theory "From Novice to Expert" in relation to the perceived impact of a preceptorship (independent variable) on the competency levels (dependent variable) of undergraduate nursing interns at King Fahad Medical City (KFMC). The term preceptorship is described as a model of teaching in which an undergraduate nurse trainee or newly graduated nurse is assigned to train under the direction of a preceptor (Billings & Halstead, 2005).Clinical competence is multidimensional in complexity and is defined as the capacity in which a graduate nurse is able to provide safe, competent nursing care utilizing the core components of the nursing process within the scope of practice as defined by the state's Board of Nursing (Benner, 1984; Jerlock, Falk, & Severinsson, 2003). For the purpose of the proposed study, undergraduate nurse intern will be defined as a new nurse who completed a 12-month program of preparatory courses followed by four full years of an undergraduate nursing degree program and is undertaking a 12-month mandatory internship program in an acute tertiary hospital setting (but is yet to be licensed as a registered nurse).

Significance of the Study

Few studies have examined the factors that prevent the multinational nursing workforce in Saudi Arabia from being effective preceptors to local undergraduate nursing interns. This study may be able to identify the relationship of the perceived level of clinical competence of undergraduate Bachelor prepared nurses to Benner's Novice to Expert Theory (1982), and identify the factors that impact the multinational nursing workforce in providing effective preceptoring to local undergraduate nursing interns. Since nursing preceptors are instrumental in evaluating and adapting programs that will meet the needs of new nurse graduates, it is necessary to the perceptions of nursing interns about their clinical competence. The findings of this research will help nursing administration and nursing faculty develop and upgrade preceptorship to an effective nursing model that will result in clinically competent local nurses.

Nature of the Project

This project studies the ability to measure the effectiveness of leadership through nursing leadership.

Research Questions and Hypotheses

The research question guiding the proposed study is: What is the relationship of the perceived level of clinical competence of undergraduate Bachelor prepared nurses to Benner's Novice to Expert theory (1982)?

H0: Preceptorship provided by multinational nursing workforce will not influence undergraduate nursing interns' perceptions of clinical competence

H1: Preceptorship provided by multinational nursing workforce will influence undergraduate nursing interns' perceptions of clinical competence

Theoretical Framework

The theory used for this project is Benner's (1982) theory "From Novice to Expert" in relation to the perceived impact of nursing preceptorship and its effects on individual and organizational effectiveness and efficiency.

Definition of Terms

Undergraduate nurse interns: For the purposes of this study, undergraduate nurse interns will be defined as new nurses who are yet to be licensed as registered nurses, have completed a 12-month preparatory course followed by four full years of an undergraduate nursing degree program and is undertaking a 12-month mandatory internship program in acute tertiary hospital setting.

Novices: Persons who have had no experience of the situations in which they are expected to perform (Benner, 1984).

Advanced beginners: Those who demonstrate marginally acceptable performance and relate with recurring meaningful situational components (Benner, 1984).

Preceptee: A newly graduated RN or undergraduate nurse trainee supervised by an experienced staff RN and giving direct care to an assigned group of patients on the unit/floor of hire (Barrett & Myrick, 1998).

Preceptors: Staff RNs, who teach, inspire, role model, counsel, and support the academic growth and socialization of the new RN for a specified amount of time into his/her new position and workplace (Billings & Halstead, 2005).

Preceptorship: Defined as a process of nursing education where a partnership of teaching-learning is formed between an experienced nurse (preceptor) and newly graduated nurse or undergraduate nurse intern (Preceptee/Novice) in a patient care environment (Aaron, 2011; Bott & Lawlor, 2011; Omansky, 2010).

Clinical Competence: Clinical competence is multidimensional in complexity and is defined as the capacity in which a nurse or student nurse is able to provide safe competent nursing care utilizing the core components of the nursing process within the scope of practice as defined by the state's board of nursing (Benner, 1984; Jerlock, Falk, & Severinsson, 2003).

Scope and Limitations

The underlying assumption of the proposed study is that the competency levels of undergraduate nursing interns who receive effective and structured preceptorship will improve. The limitation of this study will be generalisability. In Saudi Arabia, a nurse's education takes nearly 6 years to complete which includes a 12-month internship. It is unknown if this additional year will favor the KSAs undergraduate nursing interns and influence the outcome of this study. In addition male and females are trained separately and this degree of difference in preparation by gender hinders the integration of the graduates into a multicultural hospital settings and functioning clinical teams. Not working in real world situations where men and women do work together tends to serve against the essence of learning and education.

Chapter Summary

This chapter introduces the background on the potential challenges within the setting of Saudi Arabia that undergraduate nurses face and how their reliance on clinical knowledge gained during schooling influences their ability to provide safe nursing care. It highlights how the success of these nurses depends on the support they receive from their preceptor and its influence on their competency levels. With growing concerns about the nursing shortage and the increasing aging population, retaining new graduate nurses in the workforce is essential to the nursing professions' ability to provide high quality patient care. The purpose of this research is to examine the impact of preceptorship on undergraduate nurse interns' perceived competency developed during the transition experience using Benner's (1982) theory "From Novice to Expert." The study will examine newly graduated nurses who are enrolled in a full 12-month nursing internship program in an acute tertiary, university affiliated hospital. The undergraduate nursing interns perceived 'competency levels' will be assessed using Benner's competencies within an instrument that is validated for evaluating the impact of nursing preceptors on the development of clinical competency. Benner's theoretical framework of the novice-to-expert practitioner development will provide the framework for the study. The research will focus on the perceived factors that provide effective preceptorship to undergraduate nursing interns. The findings of this… READ MORE

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