Clinical Competence : the Core of Nursing Education

Abstract

This thesis takes its starting point in caring science viewing caring as the core of nursing, and acknowledging clinical caring science as a humanistic oriented science. The main aim is to define clinical competence and to describe how it can be made visible, evaluated and developed during a bachelor degree nursing education. The thesis is based on three sub-studies and seeks answers to the main questions: 1)What clinical competence is needed in nursing, and how can this competence be made evident? 2)What concepts, definitions and theoretical perspectives are used in recent studies evaluating clinical competence in nursing education? 3)What shapes and expressions does clinical competence take in simulated situations and how can clinical competence be developed by simulation? The approach in the thesis is hermeneutics, and the view on knowledge is open interpreting and understanding the world by looking, describing, valuing and reflecting (Eriksson 2017, 2010, Gadamer 1997, 1996, Helenius 1990).The thesis is anchored in ethos and the ontology formed by Eriksson (Eriksson & Lindström 2007), giving the research the sight and direction. Clinical competence showed as encountering, knowing, performing, maturing and developing, both as a stage and a process, ontological and a contextual. Ontological competence is relational executed bed-side and transferable between contexts, the contextual being more structural and local requiring contextual knowledge. In evaluating clinical competence three themes were identified; professional practice, clinical skills and reflective practice, and cognitive, affective and psychomotor skills. All three being quite holistic, and having a nursing or a caring perspective. Definitions of the clinical competence vary why being explicit about used definitions and perspectives becomes important. Clinical competence can be evaluated and developed by simulation learning by well-planned scenarios, considering all dimensions of clinical competence. Nursing education should put effort on developing an ontological clinical competence, and continuous evaluation using different methods is needed to cover both the objective and experienced competence of students´. Clinical competence depends on both internal and external factors, on the student´s personal qualities and abilities and also on the culture in the context.