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Background: While everyone agrees that it is important for nurses to be competent practitioners, no validated French questionnaire measuring nurse competence is available to date. Internationally, one of the most frequently used questionnaires used to measure the competence level of nurses working in a clinical setting is the Nurse Competence Scale (NCS). Objective: The objective of this study was to translate and culturally adapt a French version of the NCS (NCS-Fr) with nurses working in the province of Quebec (Canada). Methods: It had a multi-method design, inspired by guidelines for translation, adaptation, and validation of scales in health research. The scale instructions and items were translated from English to French by two translators knowledgeable in nursing/healthcare and then back-translated to English by two other translators. Versions were compared; ambiguities and discrepancies were resolved during a synthesis discussion. A convenience sample of registered nurses (n=8) and experts in nursing education (n=10) assessed instructions and items for comprehensibility. Results: Content validity index (CVI) for items (I-CVI) of the preliminary version ranged from 0.56 to 1, with most items (n=64) meeting the threshold of 0.78. The scale CVI (S-CVI) was 0.89. Conclusion: This study used a rigorous method to translate and adapt a French version of the NCS. The next step will be to evaluate the psychometric properties and items performance of the NCSFr.

© 2020 Background: New graduate nurses’ competence is a concern for all healthcare organizations. Previous reports show heterogeneous levels of competency amongst them. As a positive association between competency and quality of care in clinical settings has been suggested, it is essential for researchers and clinicians to select valid, reliable, and responsive scales to assess new nurses’ competence. However, a systematic evaluation of the measurement properties of scales measuring new nurses’ competence had yet to be published. Objective: To analyse, evaluate and synthesize the measurement properties of scales used to assess new nurses’ clinical competence. Design: A systematic psychometric review based on the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) methods. Data sources: The search strategy included a combination of keywords and thesaurus terms related to new graduate nurses, clinical competence, and competence assessment. Five databases were searched: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. The search was limited to full-text papers published in English or French, from 2010 to 2019. Review methods: Two independent reviewers screened eligible papers, extracted data related to validity, reliability, and responsiveness of each scale, and evaluated the quality of their measurement properties as well as risk of bias in their psychometric evaluation. Divergences were solved through discussion. Results: Ten scales were included: eight original scales, one culturally adapted and one modified. Of these scales, eight were developed or adapted in the 2010s decade and the other two scales were developed earlier. Most scales are divided into 6 to 8 subscales and use an adjectival scale with either 4, 5 or 7 points. The content validity study of all scales in this review was deemed to be doubtful or inadequate quality. Reliability was almost exclusively assessed by calculating the internal consistency with Cronbach's alpha coefficient which gives no information on equivalence or stability of the measure. Responsiveness was never properly assessed in the reviewed studies. Conclusions: There is little evidence on the measurement properties for each scale regarding their validity and reliability; responsiveness was not assessed for any scale. Every scale evaluated in this review had different characteristics (length, subscales, response options). Therefore, selection of the most appropriate scale depends on the context and purpose of the assessment. Prospero registration number: CRD42018109711 TWEETABLE ABSTRACT: Systematic review of scales measuring new nurses’ competence: we must do better and conduct more validity/reliability testing of existing scales.

© 2020 John Wiley & Sons Ltd Aim: To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses’ clinical competence in clinical settings. Design: Mixed methods systematic review. Data sources: The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 –September 2019. Review Methods: Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion. Results: About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0–6 months, but findings are inconsistent from 6-12 months. Conclusion: There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor. Impact: No recent reviews comprehensively synthesized the findings from new graduate nurses’ clinical competence. This review has found that new graduate nurses’ competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

La communication entre les milieux d’enseignement en sciences infirmières et les milieux cliniques ne se fait pas de façon optimale. L’utilisation d’un langage commun partagé par les enseignants et les formateurs cliniques, en particulier en ce qui concerne les notions de développement et de déploiement de compétences, permettrait de situer les attentes envers les étudiants et les nouveaux diplômés sur un continuum débutant lors de la formation initiale et se poursuivant dans le milieu clinique. Cet article présente un modèle de développement et de déploiement de compétences en pratique infirmière, construit théoriquement par l’intégration des travaux de Patricia Benner sur le développement de l’expertise professionnelle à l’approche par compétences. Ce modèle situe l’apprentissage expérientiel et la réflexion comme des éléments centraux du processus de développement de l’expertise infirmière menant à une pratique infirmière de qualité, influencée par le contexte dans lequel l’infirmier se trouve. D’autres études seront nécessaires afin de bonifier ou valider empiriquement ce modèle, mais son l’utilisation pourrait faciliter un dialogue entre enseignants et formateurs cliniques pour optimiser l’intégration des infirmiers en début de pratique., Communication between nursing educational institutions and clinical settings is not optimal. The use of a common language shared by nurse academics and clinical educators, particularly about the notions of competency development and deployment, would make it possible to situate the expectations towards the students and the new graduates on a continuum beginning during pre-licensure education and continuing in the clinical setting. This article presents a model for the competency development and deployment in nursing practice, theoretically constructed by integrating the work of Patricia Benner on the development of professional expertise to competency-based education. This model places experiential learning and reflection as central elements in the process of nursing expertise development, influenced by the context in which the nurse is situated. Further studies will be needed to empirically enhance or validate this model, but its use could facilitate a dialogue between academics and clinical educators to optimize the integration of new graduate nurses at the beginning of practice.

Cette étude vise à comprendre les motifs qui peuvent s’avérer source de conflits dans une situation où il est le plus inattendu : les navires de croisières. Nous analysons les constructions de la propagande de vente de croisières avec l’utilisation des mythes marins. Nous nous questionnons ensuite sur la relation entre l’être humain et la mer à partir de la grande diversité mythologique entourant celle-ci ainsi que l’expérience empirique de la vie sur un navire de croisière (également sur un paquebot, cargo et bateau militaire). Dans ce contexte touristique, nous abordons le thème de la rencontre de l’Autre : l’Autre étant les personnes habitant les destinations visitées, les touristes, et principalement, les employés sur le navire responsables du service à la clientèle. Enfin, nous analysons plusieurs conflits représentatifs vécus à bord d’une croisière afin de comprendre les structures conflictuelles ; l’espace, la subordination, les jeux de rôle, les classes sociales, etc., This study focuses on causes of conflict in a situation least expected: cruise ships. This analysis illustrates the structure of cruising propaganda and how it is linked to oceanic mythologies. Then, the study reveals the connection between humans and the sea, based on the wide mythology and one's empirical experience on a cruise ship (as well as on a liner, cargo or military ship). In a touristic context, this study focuses on the subject of encounter with The Other which, from point of view of the tourist, refers to the locals of the visited destinations, other tourists and mainly the customer service representatives of the cruise lines. The final analysis demonstrates relevant conflicts on board a cruise ship experienced by several informants. The ultimate objective of this study is to understand the causing structures of conflict such as the space, subordination, social roles, social classes, etc.

Dans les 15 dernières années, deux rapports (Frenk et al., 2010; Institute of Medicine, 2003) ont soutenu la nécessité d’une réforme dans les programmes de formation en sciences infirmières et autres sciences de la santé, afin de se baser sur une approche pédagogique par compétences (APC). Ce changement devait permettre de préparer les nouveaux diplômés à la réalité des systèmes de santé et aux défis de l’avenir. Peu d’études ont mis en évidence les compétences mises en œuvre par des infirmiers nouvellement diplômés (IND) de ces programmes réformés. Le but de cette étude était, d’une part, de décrire le déploiement de compétences d’IND d’un programme de baccalauréat basé sur une APC d’une faculté de sciences infirmières (FSI) québécoise, tel que perçu par différents acteurs dans une culture de milieu hospitalier de soins aigus et, d’autre part, de discuter de l’influence de cette culture sur ce déploiement de compétences. Pour guider cette étude, un cadre théorique a été construit, intégrant le modèle de développement de l’expertise professionnelle de Benner (1982, 1984) aux travaux de Tardif (2006) sur l’APC. Une ethnographie ciblée a été réalisée sur trois unités de soins aigus auprès de 19 acteurs-clés, soit des IND (n=4), infirmiers précepteurs (n=2), conseillers en soins infirmiers (n=9) et autres professionnels (n=4). Les données ont été collectées par des entrevues individuelles, groupes de discussion et de l’observation, et analysées selon le cadre ethnographique infirmier de Roper et Shapira (2000). Les résultats ont permis d’identifier trois thèmes. Le premier concerne les débuts professionnels des IND, l’appropriation de leur nouveau rôle, le morcellement de leur pratique en tâches et le développement de leur pratique. Le second thème porte sur la collaboration des IND dans l’équipe interprofessionnelle, la difficulté du travail en dyade avec l’infirmière auxiliaire et leur facilité à maintenir une relation avec les patients et leur famille. Le dernier thème concerne la pratique scientifique des IND, leur curiosité scientifique accrue ainsi que leur utilisation de sources scientifiques et crédibles qui doivent être encouragées. Les éléments décrits dans ces trois thèmes ont été analysés à la lumière du référentiel de compétences pour conclure que les IND déploient sept des huit compétences développées pendant leur formation initiale. Des facteurs organisationnels influencent ce déploiement de compétences, soit le programme d’accueil et d'orientation, la stabilité d’unité et d’horaire, la charge de travail et la culture scientifique de l’unité de soins. Des facteurs individuels ont aussi un impact, soit la personnalité et les stages effectués pendant la formation initiale des IND, l’identification de modèle de rôle, l’intégration des IND à l’équipe et la dénonciation de comportements d’intimidation de la part d’autres infirmières et finalement, la reconnaissance de l’expertise infirmière par les autres professionnels. Les connaissances découlant de cette étude permettent de mieux comprendre la transition d’IND d’un programme basé sur l’APC, lorsqu’ils débutent leur pratique professionnelle. Elles ont des retombées pour les différents champs d’activité de l’exercice infirmier et permettront d’améliorer les programmes de formation initiale et d’adoucir la période de transition entre le milieu de formation et le milieu clinique., In the last 15 years, two important reports (Frenk et al., 2010; Institute of Medicine, 2003) have supported the need for reform in nursing education and other health sciences curricula to build on competency-based education (CBE). This change was intended to prepare new graduates for the reality of health systems and future challenges. Few studies have focused on how newly graduated nurses (NGNs) from these reformed programs use the competencies they have developed. The purpose of this study was twofold: first, to describe the deployment of competencies of NGNs from a competency-based undergraduate nursing program in a Quebec faculty of nursing, as perceived by various actors in acute care settings and second, to examine the influence of the culture of acute care settings on competency deployment by NGNs. To guide this study, a theoretical framework integrating Benner’s professional advancement model (1982) to Tardif’s work on competency-based education and competency development (2006) was built. A focused ethnography was conducted on three acute care units of an academic hospital. Convenience and snowball sampling strategies were used to recruit 19 key actors: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and other professionals (n = 4). Data were collected through individual interviews, focus groups and observation, and analyzed according to Roper and Shapira (2000) ethnographic nursing analysis framework. Three themes were identified to describe the deployment of competencies of NGNs. The first theme concerns the professional beginnings of NGNs, the appropriation of their new role, the fragmentation of their practice into tasks and the development of their practice. The second theme relates to the collaboration of NGNs in the interprofessional team, their difficulty in the management of the intraprofessional team with licensed practical nurses and their ability to maintain a relationship with patients and families. The last theme concerns the scientific practice of NGNs, their increased scientific curiosity and their use of scientific and credible sources that must be encouraged. The elements described in these three themes were analyzed in the light of the competency framework to conclude that the NGNs deploy seven of the eight competencies developed during their training. Organizational and individual factors were identified as influencing the deployment of competencies of NGNs. Organizational factors are orientation, stability, workload, as well as the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial training; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognize nursing expertise. The knowledge gained from this study provides a better understanding of the competencies of NGNs and the elements influencing the beginning of their practice. These results have implications for the various fields of nursing practice and will help improve initial training programs and ease the transition period between the academic environment and the clinical setting.

Objective \ud \ud \ud \ud The aim of this mixed methods systematic review was to: i) document the interventions that support and facilitate graduate nurse transition from university to practice in a diversity of healthcare settings and ii) to identify outcomes from graduate nurse transition interventions for the graduate, patient or client, and health service. \ud \ud \ud \ud Design \ud \ud \ud \ud This mixed methods systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria. The protocol was registered with Prospero. \ud \ud \ud \ud \ud \ud Data sources \ud \ud \ud \ud Primary research studies located in Medline, EmBase, CINAHL, Prospero, Cochrane Library, PsycInfo, and Web of Science (Social Science Citation Index). All quantitative, qualitative, and mixed methods studies were included if they met the inclusion criteria. \ud \ud \ud \ud Review methods \ud \ud \ud \ud Using a comprehensive search strategy, retrieved articles were screened by two reviewers at the title, abstract, and full-text stage. Reviewer disagreements were discussed until consensus was achieved. The well-validated Mixed-Methods Appraisal Tool was used to assess quality of the quantitative, qualitative, and mixed methods studies. \ud \ud \ud \ud Results \ud \ud \ud \ud A total of 130 studies were included as the review dataset. There was a myriad of terms used to describe transition interventions, and programme length and settings varied. The content of transition interventions was not well defined, and there was a lack of studies outside acute hospital settings. Data collection methods varied widely. The majority of authors reported outcomes for the graduate or the graduate and service, with only one reporting outcomes for the patient or client. There was a significant variation in quality across the studies. \ud \ud \ud \ud Conclusions \ud \ud \ud \ud This review addresses a significant gap in the literature by documenting transition interventions in a diversity of health settings and outcomes from these interventions. Interest in transition to practice continues to rise, but there is an urgent need to conduct well designed, robust, and larger-scale studies at the national and transnational levels. \ud \ud \ud \ud Keywords - Graduate; transition; practice; systematic review.