© Borgis - New Medicine 3/2009, s. 70-74
*Ibolya Tulkán, Erika Erdősi, Magdolna Pogány, Kornélia Helembai
Hungarian Nurses and Nurse Graduates´ Competences in International Context
University of Szeged, Faculty of Health and Social Sciences, Department of Nursing, Hungary
Head: Dr Kornélia Helembai, PhD
Summary
Aim. The aim of this article is to show how graduates finishing the 4-year BSc nursing training in 2007 and undergraduates finishing their training in 2008 shortly before their final exams assess their competences, and to compare the strengths and weaknesses of Hungarian nursing practice with the international results.
Material and methods. Nursing competency has always been a topic of interest and a subject of debate in Hungary. There are no data available in Hungary that are suitable for international comparison on what competences can be practised in Hungarian healthcare. The method of data collection was carried out by questionnaire. 6 training sites of 3 training institutions were selected. A total sample of 458, from which a sample of 123 students graduated in 2007 (N = 123) and a sample of 335 undergraduate students were graduating in 2008 (N =335), was surveyed. The analysis of data was performed using the SPSS statistical package. Assessment of relations between variables was performed by Kruskal-Wallis test and Friedman test.
Results. A common feature of the Hungarian and international findings is that the care delivery competence domain is the first, and research and development is the last in the rank, but there are country-specific features as well.
Conclusion. The results of the research can serve as a basis to develop nursing education.
Introduction
The European Union aims to be the most dynamic and competitive knowledge-based area in the world by 2010. Keys to this initiative are education, training, development of competences and strengthening the connection between economy and training [1]. European nursing training and nursing practice are greatly influenced by the EU´s strategic decisions, supported by several international projects [2-5]. Although nowadays great emphasis is put on the competence-based approach, there is no universal definition [6-10] or measurement tool [11-14] for comparing transparency and diversity of nursing qualification, training and practice.
There are no suitable data available in Hungary for national or international comparison on what nursing competences can be practised in Hungarian healthcare and how the gap between the training and the possibilities and expectations of the healthcare institutions should be approached. The problems of nursing training and practice in Hungary – e.g. decrease of interest in the nursing profession [15], absence of reinforcements, over-loaded nursing staff [16], lack of social recognition of the profession [17], well-trained nurses seeking employment abroad or leaving their profession [16] – demand even more accurate preparation for competences.
Aim
Our aim was to study what competences can be used in Hungarian nursing practice, what are the strengths and weaknesses of Hungarian nursing practice in an international context, and what conclusions can be drawn to develop the education programme of the training institutions.
Material and methods
The study took place from January to May 2008. Selection of samples was carried out by random sampling, using a multi-step method. At the first stage 6 training sites of 3 training institutions were selected, at the second stage students who graduated from BSc training and obtained a college leaving certificate in 2007 and undergraduate students shortly before their final exams in 2008. The training institutions were similar considering their schooling regions, number of students, the regional practical background, the educational programme and location.
The EHTAN NCQ self-assessment questionnaire [2] supplemented with some demographic items, was used in the research. EHTAN NCQ is the only competence-related questionnaire relevant to current nursing practice in Europe; hence it can serve as a basis for international comparison. EHTAN NCQ was originally used with nurses working at acute general medical and surgical units. The questionnaire focuses on 8 competence domains (Table 1). The frequency of performing each of the listed competences had to be rated on a four point scale (where never = 1, occasionally = 2, usually = 3, always = 4) [2].
Table 1. Friedman probe by competence-domains Mean number in rank N = 455 (Number of participants).
| Competence-domains | Number in rank /Mean | Order of rank |
| Care delivery | 6,12 | 1. |
| Professional and ethical practice | 5,94 | 2. |
| Communication | 5,70 | 3. |
| Team-working | 4,53 | 4. |
| Health promotion | 4,45 | 5. |
| Personal and professional development | 4,20 | 6. |
| Assessment | 2,89 | 7. |
| Research and development | 2,16 | 8. |
Recording and analysis of data was performed by SPSS for Windows 15.0, using descriptive statistical methods. Assessment of relations between variables was performed using Kruskal-Wallis test and Friedman test.
Results
The distribution of students who graduated in 2007 and undergraduates graduating in 2008 is shown in Fig. 1. A total sample of 458, from which a sample of 123 students graduated in 2007 (N = 123) and a sample of 335 undergraduate students were graduating in 2008 (N =335), was surveyed. 9.75% of the respondents who graduated in 2007 and 20% of the undergraduate students graduating in 2008 were regular students. 90.24% of students who graduated in 2007 and 80% of undergraduate students graduating in 2008 were correspondent students. The proportion of those aged 31-35 was the highest (27%). The study sample was characterized by female dominance. The majority of respondents, 90.2% of the students who graduated in 2007, and 77.9% of students graduating in 2008, were employed at the time of the study. Most of them worked at clinics or hospitals. (Fig. 2) 72.2% of the employed respondents were working as nurses (BSc nurses, specialist nurses) – senior nurse managers are excluded, while middle nurse managers are included, as they are involved in everyday nursing activities. (Fig. 3) The great majority of the respondents have been working for more than 7 years.
Fig. 1. Distribution of students graduated in 2007, undergraduates graduating in 2008
according to the training sites (N = 458).
§ Training sites: K1, K2, K3, K4, K5, K6
N= Number of participants
Fig. 2. Distribution of working respondents according to the level of care (%).
N=308
N = Number of respondents
Fig. 3. Distribution of respondents working as nurses according to their position in (%).
N = 371
N= Number of respondents
Comparison of self-assessment of competence domains
The Friedman test was used to compare the averages relating to competence domains and a significant difference was indicated (p =0.000). On the basis of the data (Table 1) it can be concluded that care delivery was rated the highest among the competence domains. Assessment and research and development received the lowest means.
Comparison of self-assessment of competence domains by training site
For the 2007 students the Kruskal-Wallis test showed no significant difference between training sites, while for the 2008 students the evaluation of research and development domain was significantly different (p =0.001).
Comparison of self-assessment of competence domains by types of training
The Kruskal-Wallis test can prove that the regular students ranked the assessment domain significantly higher than the correspondent students (p =0.036).
Relation of self-assessment of competence domains with the working period
No significant correlation can be observed between the working period in healthcare and/or social working area and the means of competence self-assessment.
Self-assessment of competence domains depending on the study achievement
The Kruskal-Wallis test indicated a significant correlation. The poorer the students estimated their study achievement, the lower they ranked the personal and professional development (p =0.003), the professional and ethical practice (p=0.001), the research and development (p =0.002) and the team-working domains (p =0.021).
Self-assessment of competence domains by students employed as nurses
Special attention was paid to the competence self-assessment of participants employed as nurses in order to compare our results completely with the findings of the EHTAN survey. The Kruskal-Wallis test proved that the conclusions valid for the total sample were valid for the sample of participants employed as nurses in all the above-mentioned aspects.
Self-assessment of competence domains by positions and units
To verify that EHTAN NCQ is reliable in measuring undergraduate nursing students as well, the Kruskal-Wallis test was performed in three aspects. Firstly, participants employed as nurses were compared to those who are not employed as nurses (or not employed at all). Secondly, participants employed as nurses were compared to those working in other positions. Finally, competence self-assessment of nurses working at general medical and surgical units was compared to that of participants employed as nurses and to the total sample. The Kruskal-Wallis test was performed for each analysed aspect and it indicated a significant difference only in the care delivery domain (p =0.000).
Comparison between the study results in Hungary and the international results
What the results of the Hungarian study (Table 2) and the international results [2] have in common is that the care delivery competence domain is ranked among the first, while the research and development competence domain is the last in the rank. The communication, professional and ethical practice and teamwork competence domains – although in the Hungarian rank professional and ethical practice is the second, communication is the third and teamwork is the fourth in the rank – fall behind the means of competence of the countries participating in the EHTAN project.
Table 2. Hungarian mean competence scores by domain.
| Competence domain | Nurses in medical/surgical units | All nurses** | Total number |
| N*=79 | N = 275 | N = 458 |
| Assessment | 2.55 | 2.54 | 2.53 |
| Care delivery | 3.37 | 3.20 | 3.12 |
| Communication | 3.10 | 3.08 | 3.05 |
| Health promotion | 2.93 | 2.87 | 2.85 |
| Personal and professional development | 2.87 | 2.82 | 2.81 |
| Professional and ethical practice | 3.12 | 3.10 | 3.10 |
| Research and development | 2.31 | 2.26 | 2.30 |
| Teamworking | 2.85 | 2.89 | 2.87 |
N*= number of participants
All nurses**: including medical-surgical nurses
Discussion
On the basis of the participants´ working and practical placement experiences it could be revealed what competences can be practised in Hungarian nursing as well as the preparatory role of the educational institutions. Comparing the training sites, a significant difference was found only in the research and development domain, which cannot be explained by different educational processes of the educational institutions, but rather by the fact that the 2008 students had to write their theses during the period of the study, and they were not at the same stage in their individual research activity. The fact that a significant difference was found in only one domain (research and development) indicates similarity in the nursing practice and in the outcome competences of the colleges.
Comparing the types of education, the fact that the assessment competence was ranked significantly higher by the regular students reflects the strong influence of values and methods emphasized during education. Correspondent students (who work and study at the same time) attach less importance to this competence, which shows that the consistent application of this competence is not expected by healthcare institutions so there is disharmony between education and practice.
In accordance with the international literature [14] no significant correlation was detected between the working period in health care and competence self-assessment, but further research is needed to explain this result. The association between the weak academic performance and poor self-assessment in the four mentioned domains also needs further investigation.
Hungarian and international results (from England, Germany, Spain and Belgium) are identical in the high self-assessment of the same 4 competence areas from the studied 8, which are: care delivery, professional and ethical practice, communication and teamwork. Moreover, in the Hungarian as well as in the international results, the competence area of research and development proved to be the weakest, according to the participants of the questionnaire. Greece differed from this trend in having the personal and professional development competence on a higher level than care delivery [2].
Hungarian and international results differ in having the mentioned top four competencies in a different order, and in the fact that, in the Hungarian study, even the most highly ranked areas (2: professional and ethical practice, 3: communication, 4: teamwork) have a lower total than they have in international studies (in England, Germany, Spain, Belgium and Greece) [2].
However, the results also prove that Hungarian nursing practice – and in an indirect way the educational institutions – offers poorer opportunities to practise professional-ethical, communicational and teamwork competences, due to the lack of conditions of nursing practice, the methodological problems of education and deficiency in the cooperation of theoretical and practical training.
Measuring real-life nursing competence with self-assessment can be an optimal tool for either personal development [2, 13, 14] or developing nursing practice and education [2, 6, 12], within separate nations as well as on an international level.
Conclusions
1. A consensus of professionals is essential to clarify the concept of nursing competence in Hungary.
2. It is necessary to strengthen the research and development, the professional and ethical practice and the teamwork competence domains with student-centred educational methods.
3. The fact that a significant difference was evidenced only in self-assessment of care delivery indicates that EHTAN NCQ is applicable to measure final year nursing students´ competences as well.
4. The detailed results of this research can serve as a basis for development of the curriculum by particular institutions, to suggest further research trends, and to improve Hungarian and international cooperation.
Piśmiennictwo
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