title: The clinical nursing competences and their complexity in Belgian general hospitals.
abstract: OBJECTIVE
  This paper reports a study whose aim was to chart clinical nursing competences and their complexity in Belgian general hospitals.
  
  
  BACKGROUND
  Competence is an essential factor for assuring quality, safety and cost-effective health care. As clinical competence cannot be evaluated separately from the clinical context in which decisions are made, competence is defined as functional adequacy and the capacity to integrate knowledge and skills with attitudes and values into the specific contexts of practice.
  
  
  METHODS
  The study took place in 2003 and focused on basic care, specialized care and elder care. Head nurses of 176 departments processed 521 patient situations. Experts selected 50 situations per area. In a Delphi procedure 100 experts described the nursing competences required in each situation necessary to provide quality acceptable care. The experts determined the global complexity of each of these competences as well as the complexity of the cognitive, psychomotor and affective aspects.
  
  
  RESULTS
  The global complexity of the various care areas was similar. Cognitive and affective aspects of competences scored higher than psychomotor aspects. Simple and average situations did not show any significant difference with regard to complexity and were less complex than difficult situations, which obtained the highest complexity score. The complexity of emergency situations did not differ from that of difficult situations.
  
  
  CONCLUSIONS
  Emergency and difficult situations require more competences than offered by basic nursing education. The continuous presence of care providers with additional education is necessary for each care area to respond adequately to emergency and difficult situations. Nurses with additional academic qualifications need to be available for consultation. There are only a few possibilities of employing lower qualified staff in direct care, with the exception of support with regard to administrative tasks. Cognitive and affective aspects of the competences require particular attention during the education programme.
authors.affiliation: Nursing Science, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium. tom.defloor@ugent.be
authors.forename: Tom
authors.initials: T
authors.lastname: Defloor
authors.forename: Ann
authors.initials: A
authors.lastname: Van Hecke
authors.forename: Sofie
authors.initials: S
authors.lastname: Verhaeghe
authors.forename: Micheline
authors.initials: M
authors.lastname: Gobert
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Darras
authors.forename: Mieke
authors.initials: M
authors.lastname: Grypdonck
mesh_terms: D000328:Adult; D001530:Belgium; D002983:Clinical Competence; D003071:Cognition; D003697:Delphi Technique; D006769:Hospitals, General; D006801:Humans; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology / Q000592:standards*; D011597:Psychomotor Performance; D013647:Task Performance and Analysis