Skills acquired in research and public health in the specialty of family and community nursing in the Valencian Community

Enferm Clin. 2017;27(5):303---307

www.elsevier.es/enfermeriaclinica

BRIEF ORIGINAL ARTICLE

Skills acquired in research and public health in the specialty of family and community nursing in the Valencian Community夽 Pedro García-Martíneza,∗ , Ruth Lozano-Vidala , María del Carmen Herraiz-Ortiza , Eladio Collado-Boirab a b

Sociedad Valenciana de Enfermería en Atención Primaria (SEVAP), Valencia, Spain Universidad Jaume I de Castellón, Castellón de la Plana, Spain

Received 26 July 2016; accepted 10 July 2017 Available online 4 October 2017

KEYWORDS Nursing in community health; Nursing in public health; Nursing of primary care; Education

Abstract Objective: To evaluate the acquisition of skills in research and public health specialists in family and community nursing. Method: Descriptive and analytical study on a population of specialist nurse members of with the Valencian Primary Nurse Society. Measured with anonymous self-administered questionnaire on activities implemented and turnaround time in the training period. The questionnaire was conducted and reviewed based on the training programme of the specialty. Results: Sixteen of the 41 specialists responded. The four year groups of nurses who had finished their training were represented as well as seven national teaching units. The results show high heterogeneity in the activities developed in the training. The average rotation in public health is 7.07 weeks, with range of 0---16 weeks. The mean number of educational sessions is 2.69 in the two years. The average number of research projects is 1.19. Conclusion: The result shows a specialisation process with training gaps in the skills of research and public health that could be remedied. Some practitioners claim that they finish their specialisation without undertaking research activities or completing the minimum proposed shifts. There is no process of improvement in the four year groups studied. © 2016 Elsevier Espa˜ na, S.L.U. All rights reserved.

DOI of original article: http://dx.doi.org/10.1016/j.enfcli.2017.07.007 Please cite this article as: García-Martínez P, Lozano-Vidal R, Herraiz-Ortiz MC, Collado-Boira E. Competencias adquiridas en investigación y Salud Pública en la especialidad de Enfermería Familiar y Comunitaria en la Comunidad Valenciana. Enferm Clin. 2017;27:303---307. http://dx.doi.org/10.1016/j.enfcli.2017.07.007 ∗ Corresponding author. E-mail address: [email protected] (P. García-Martínez). 2445-1479/© 2016 Elsevier Espa˜ na, S.L.U. All rights reserved. 夽

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PALABRAS CLAVE Enfermería en salud comunitaria; Enfermería en Salud Pública; Enfermería de atención primaria; Educación

P. García-Martínez et al.

Competencias adquiridas en investigación y Salud Pública en la especialidad de Enfermería Familiar y Comunitaria en la Comunidad Valenciana Resumen Objetivo: Valorar la adquisición de competencias en investigación y Salud Pública de los especialistas en Enfermería Familiar y Comunitaria. Método: Estudio descriptivo y analítico sobre población de enfermeros especialistas asociados a la Sociedad Enfermera Valenciana de Atención Primaria. Medido con cuestionario anónimo y autoadministrado sobre actividades implementadas y tiempo de rotación en el periodo de formación. Cuestionario realizado y revisado en base al programa formativo de la especialidad. Resultados: Responden 16 de los 41 especialistas. Existe representación de las cuatro promociones que han acabado su formación y siete unidades docentes nacionales. Los resultados muestran alta heterogeneidad en las actividades desarrolladas en la formación. La estancia media en Salud Pública es de 7,07 semanas, con rango de 0 a 16 semanas. El número de sesiones educativas medio es de 2,69 en los dos a˜ nos. La media de proyectos de investigación es de 1,19. Conclusión: El resultado muestra un proceso de especialización con carencias formativas en las competencias de investigación y Salud Pública que podrían subsanarse. Algunos profesionales afirman que acaban la especialización sin desarrollar actividades de investigación y con rotatorios que no alcanzan los mínimos propuestos. No se observa proceso de mejora en las cuatro promociones estudiadas. © 2016 Elsevier Espa˜ na, S.L.U. Todos los derechos reservados.

What is known? Specialist family and community nurse training started in 2011, with skills in research and public health as key differentiating elements. However there is little literature on these aspects because the specialty is so new.

What do we contribute? A review of the training programme for the specialty and an assessment of the skills developed by means of minimum activity indicators. We contribute information towards furthering improvement in specialist training.

Introduction The Spanish Royal Decree on nursing specialties1 was passed in 2005 and the training programmes for 6 of the 7 specialties were published between 2009 and 20112---7 ; these included the Family and Community Nursing programme (F and C N). All of the programmes cover research skills, which have been identified as crucial elements in transforming the profession8 and have enabled access to doctorates through internal nursing resident training. In the various training programmes for nursing specialties, skills acquisition is consolidated using indicators of

the minimum activities to be undertaken during the training period. However, these indicators are not covered in the family and community nursing2 specialty because it is assumed that research skills will be acquired through the cross-sectoral approach of the training. Training in public health is another skill to be developed, and this only appears specifically in the F and C N specialty. A 4 week public health rotation is suggested in the training programme as well as participation in minimum activities in 3 community intervention sessions in the areas of child, adult, sexual and reproductive health. Training in F and C N started in 2011 and the first intake graduated in 2013. Since then, the number of places has continued to increase; there were 132 places on offer in 2011, and 278 in 2016. By 2016, there had been four intakes with 860 new specialties. In 2015, the Primary Care Nursing Organisation of Valencia (SEVAP) set out to combine the autonomous community’s new F and C N specialties and managed to net 41 members with a specialist profile. Research and public health training are two elements that will enable the specialty of F and C N to be developed. Our objective was to describe the level of training achieved in both areas by F and C N specialists through scientific activities, community interventions and rotation periods in public health units and compare them with the minimum activities suggested in the training programme.2

Method A cross-sectional, descriptive and analytical study of F and C N specialists, members of SEVAP, who graduated as specialists up until 2016, agreed to participate in this study

Acquisition of skills in research and public health specialists anonymously and allowed their data to be used for scientific purposes. A self-administered ad hoc questionnaire was created (Table 1) and prepared by three nurses. It was reviewed by five members of SEVAP and the proposed amendments were entered. The final questionnaire was presented at a scientific and informative meeting of SEVAP, as part of a general study of the status of specialists in the Valencian Community, and members were asked to participate. In May 2016, the questionnaire was sent by email to all the members of SEVAP who met the inclusion criteria, and they were asked to respond by email within 15 days. The members were sent a reminder email 10 days after the first. The data were described and analysed in June 2016 using SPSS 20.0 statistical software. The quantitative data was presented as mean and standard deviation, and the qualitative data as percentage and absolute response number. The ‘‘year of completing the specialty’’ variable was re-coded in two groups; the years that ended in 2013 and 2014 were identified as the first intake and those that ended in 2015 and 2016 as the final intake. Analysis of the data relating to the first and final intakes was analysed using the parametric or non-parametric tests corresponding to each analysis. In order to preserve the autonomy and privacy of the participants, the questionnaire was anonymous and the participants were asked if the data could be used for scientific studies. To ensure the privacy of participants the data were received and tabulated by one member of the team and were analysed by another using a blind system. The questionnaires were coded as they were entered into the database.

Table 1

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Results Of the 41 members of SEVAP who met the requirements for participating in the study, 39.02% responded (n = 16), with a distribution by sex of 2 males and 14 females (12.5 versus 87.5%), the mean age was 31.75 years ± 4.85 and the mean time since gaining their nursing qualification was 8.53 ± 4.87 years. The four intakes were represented by 2, 4, 6 and 4 specialists respectively; 7 teaching units, 10 health centres and 11 national hospitals. The mean time spent in a specific public health rotation was 7.07 ± 4.85 weeks, with a range of between 0 and 16 weeks. The poor participation in descriptive and experimental studies in the scientific and community intervention training activities (Table 2) was highlighted, and the difference in participating in clinical sessions in a primary care (9.2 ± 24.3) and hospital setting (0.63 ± 0.62). There was an unusual case that reported having completed 100 clinical sessions in the area of primary care, without a mean of 3.1 sessions per specialist being obtained. Highlighted from the individual study of community research and intervention activities were: 6 specialists who had completed 4 or fewer weeks’ training in public health, 5 specialists who had completed 2 or fewer clinical sessions in primary care, 7 specialists who had not undertaken clinical sessions in a hospital setting, and 8 specialists who had performed two or fewer interventions in community education. It is also remarkable that 5 specialists stated that they had not participated in any descriptive nursing study, 11 that they had not participated in multidisciplinary

Questionnaire and variables used in the study. Personal information and training centres Age (years) Sex (male- female) Intake (start year- final year) Teaching unit Health centre/reference hospital Years since completion of diploma/degree Rotation units

Number of weeks in rotation

Public health: state area……. Scientific activities undertaken

Clinical sessions in the health centre Clinical sessions in hospital Community education sessions Participation in descriptive nursing studies Participation in multi-professional descriptive studies Participation in experimental nursing studies Participation in multi-professional experimental studies Scientific publications Attendance and conferences

Activities undertaken

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P. García-Martínez et al.

Table 2 Descriptive data of the entire sample (global data). Comparison between activities completed in the initial intake and those completed in the final intake. Standard deviation (SD). Global data (n = 16)

Weeks in public health Clinical sessions in primary care Clinical sessions in hospital Group/community education Descriptive nursing studies Descriptive multi-professional studies Experimental nursing studies Experimental multi-professional studies Publications Conferences

Initial intake (n = 6)

Final intake (n = 10)

Mean

SD

Mean

SD

Mean

SD

7.07 9.2 0.63 2.69 1.19 0.31 0.25 0.06 1.19 1.69

4.85 24.3 0.62 1.14 1.33 0.48 0.45 0.25 1.47 1.01

7.67 13.2 0.4 2.8 1.3 0.2 0.3 0.1 1.3 2.0

5.15 30.56 0.52 1.23 1.57 0.42 0.48 0.32 1.77 1.15

6.17 2.5 1 2.5 1.0 0.5 0.17 0 1.0 1.17

4.66 1.05 0.63 1.05 0.89 0.55 0.41 0 0.89 0.41

descriptive studies, 12 had not participated in experimental nursing studies, and 15 of the 16 specialists claimed not to have participated in multidisciplinary experimental studies. Finally, it is noteworthy that 6 specialists claimed not to have published a paper and 10 had only attended one scientific conference during their two years of training. The specialists’ training in the first and final intakes is shown in Table 2. No significant differences are shown, although a decrease can be observed in rotation time in public health and in participation in clinical sessions or at scientific conferences.

Discussion The lack of studies found on compliance with indicators in specialist nurse training programmes in Spain makes it impossible for us to compare results. However, this study gives us food for thought about specific training time on public health and research and, given the little coverage of this training by different authors who have studied F and C N specialist training,9---11 we consider it to be insufficient. The lack of research indicators observed in the majority of specialist programmes, apart from paediatric and occupational health nursing, questions whether research is indeed recognised for professional development, as stated by some authors.8 Comparison of the minimum activities of the nursing specialties flags up great differences between them. These range from the occupational health specialty which presents indicators for clinical sessions, research projects, publications, communications to conferences and community education sessions, to the specialties of F and C N and obstetrics and gynaecology, which only have indicators for group education sessions.2---7 The heterogeneity in participating in these activities leads us to assume that there is a lack of homogeneity in specialty training, F and C N being particularly undermined as demonstrated by the study data. Comparison of the different intakes does not show any process of improvement, and this shortcoming in training has been left unresolved. As was already guessed when the specialty started,11 it might be that the lack of training and experience of the tutors could be a factor to be

p

0.570 0.297 0.081 0.613 0.634 0.280 0.566 0.343 0.660 0.060

corrected, and that continuous improvement cycles are necessary because as Sánchez10 states, we learn by doing. The limitations of this study include the small sample obtained, which restricts extrapolation of the data, which should be interpreted with caution, confining the results to SEVAP specialists. The memory bias is also a limitation which we tried to reduce by giving fifteen days to respond to the survey, and there was no pilot survey. The participant who stated that they completed 100 clinical sessions confirmed that this was not an error, and therefore we must assume that this information is correct. It should be highlighted that reviewing F and C N specialty training is a recent departure and a more ambitious study could be planned with access to a representative sample of nurses in this specialty.

Conflict of interests The authors have no conflict of interests to declare.

Acknowledgements We would like to thank all the SEVAP members who helped in undertaking this study.

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