The Development of Nursing Education Model and The Instrument for Improving Clinical Competence

실무수행능력 중심의 교육모형 및 측정도구 개발

The revolution of nursing curriculum has been focused on clinical competency for nursing graduates to flexibly respond to changes in societal health needs and disciplinary requirements. In this trend, the study was designed to identify basic concepts of nursing education that reflects the changes in societal needs and nursing discipline, and to develop the instrument to measure performance level in each dimension of clinical competency. The study was conducted in two phases. In phase 1, principal concepts consisted of nursing education were determined through literature review as well as series of discussion sessions on nursing philosophies and educational objectives among researchers. Though the process, the conceptual framework of competency based nursing curriculum was constructed with nursing process and professional role as horizontal threads, client, health needs, and nursing interventions as vertical threads. Then, items were developed to represent each dimension of competency : client and health need, nursing process, professional role, and nursing interventions. The total of 273 items were included as to represent clinical competency required for BSN graduates. In phase 2, questionnaires were distributed to nursing faculties of 41 BSN programs to validate the 273-item Instrument developed to measure competency. The total of 34 subjects returned the questionnaire with 81% of response rates. The subjects of the study had an average of 42 months of clinical experience and 13 years of education experience in various nursing areas with an age range of 30 to 52 years. The data were analyzed by utilizing SPSSWIN and the results are as follows. 1) The mean score of the nursing process dimension was supported most with the mean of 3.60(SD=0.32) compared to client and health need dimension(M=3.49, SD=.40), professional role(M=3.41, SD=.44), and nursing interventions(M=3.57, SD=.34). 2) The dimensions of competency were moderately correlated to each other with a range of r=.433 to r=.829, confirming that four dimensions of competency were related but distinct concepts. 3) The items of each dimension were analyzed based on its appropriateness. 'Assessing risk factors of the clients' were most highly supported in client and health need dimension. Most items of nursing process dimension were considered appropriate, while items related to efficient communication were well supported in professional role dimension. In nursing intervention dimension, items on basic nursing skills were highly supported while items on specific nursing interventions such as music therapy or art therapy were considered relatively inappropriate to competency for BSN graduates. The findings clearly showed that the current nursing education more emphasizes nursing interventions based on nursing process than other dimensions of competency. There is a need to reconceptualize nursing curriculum that is able to reflect more of nursing professional role and client/health need dimensions. Further research to validate the instrument by confirming competency dimensions of nursing graduates who are currently working at the hospital has been suggested.