The Journal of Continuing Education in Nursing

Original Article 

Specific Competencies of Prehospital Emergency Nursing: The Views of Spanish University Professors

Ana Vázquez-Casares, PhD, MSN, RN; Javier Vidal, PhD

Abstract

Background:

The guarantee of nursing competence in prehospital urgent care requires the identification and delimitation of the specific competencies. This work describes the importance attributed by professors of Spanish universities to the competencies of prehospital nursing positions and indicates the most appropriate training level required to achieve them.

Method:

The current work consisted of a survey with an online questionnaire. Sixty competencies over 10 domains were studied.

Results:

The most valued domains were those of general and personal competencies. The competencies considered most important were “Recognizes the vital risk and knows how to perform basic and advanced life support maneuvers” and “Provides quality health care.” The nursing degree is considered appropriate to train students to the required level in only eight competencies.

Conclusion:

The proposed competencies can be considered as specific competencies necessary in prehospital emergency nursing. Effective performance requires training to a higher level than a nursing degree. [J Contin Educ Nurs. 2020;51(12):556–567.]

Abstract

Background:

The guarantee of nursing competence in prehospital urgent care requires the identification and delimitation of the specific competencies. This work describes the importance attributed by professors of Spanish universities to the competencies of prehospital nursing positions and indicates the most appropriate training level required to achieve them.

Method:

The current work consisted of a survey with an online questionnaire. Sixty competencies over 10 domains were studied.

Results:

The most valued domains were those of general and personal competencies. The competencies considered most important were “Recognizes the vital risk and knows how to perform basic and advanced life support maneuvers” and “Provides quality health care.” The nursing degree is considered appropriate to train students to the required level in only eight competencies.

Conclusion:

The proposed competencies can be considered as specific competencies necessary in prehospital emergency nursing. Effective performance requires training to a higher level than a nursing degree. [J Contin Educ Nurs. 2020;51(12):556–567.]

The definition of the specific competences of a role, understanding competence as the management of personal attributes, knowledge, skills and attitudes, and ethical attributes and their values for the effective performance of a professional role (Cowan et al., 2007; Leung et al., 2016; Meretoja et al., 2004), is determined by the specific work context (Andersson & Kerstin, 2009; Cowan et al., 2007; Leung et al., 2016; Meretoja et al., 2004; Oliveira & Martins, 2013; Salonen et al., 2007). An operational definition of competencies must be based on the knowledge and real needs of the job, and the training of professionals must be orientated toward their future labor needs (Henrik & Kerstin, 2009; Meretoja et al., 2004; Nilsson & Lindström, 2017; Salonen et al., 2007). The delimitation of the competencies of prehospital emergency nursing needs to be framed in its professional context. The prehospital emergency care model in Spain is based on a medicalized model, with the presence of nurses in ambulances being part of the response resources at the second or advanced level (González et al., 2014; López & Alvarez, 1995). This model is similar to that of other European countries, such as Sweden, Finland, Norway, the Netherlands, Portugal, and Poland. The broad definition of nursing values in this mode of prehospital emergency care, safety, and quality (Andersson et al., 2014; Oliveira & Martins, 2013; Sjölin et al., 2015) is hampered by the absence of a formal definition of the competencies attributed to prehospital emergency nursing and to the lack of standardization of training programs (Aftyka et al., 2014; Leung et al., 2016).

Currently, no specific recommendations in European countries specify the competencies required of these professionals (Nilsson & Lindström, 2017), although there is general agreement on the high level of qualification found in ambulance nursing in Europe, especially those regarding advanced practice (Andersson et al., 2014; López & Alvarez, 1995; Ordem dos Enfermeiros, 2018; Sjölin et al., 2015; Wihlborg et al., 2014).

In this sense, several European studies analyze which competencies are specific to the role from two perspectives: from the viewpoint of professionals through questionnaires or interviews, with the aim of establishing their professional boundaries (Andersson et al., 2012; Suserud, 2005; van Schuppen & Bierens, 2011; Wihlborg et al., 2014); and from the viewpoint of the students during their training as prehospital care specialists, through the analysis of the training needs detected (Axelsson et al., 2016; Berntsson & Hildingh, 2013; Nilsson & Lindström, 2017).

The competencies are organized by thematic areas forming domains (Figure 1). Within the competencies assigned to prehospital emergency nursing, technical competencies are referred to as dominant functions, given that they involve initial and comprehensive assessment of situations, as well as diagnostic and advanced therapeutic interventions (Aftyka et al., 2014; Andersson et al., 2012; Andersson et al., 2014; Franco & Perán, 2014; Nilsson & Lindström, 2017; Sjölin et al., 2015; van Schuppen & Bierens, 2011; Wihlborg et al., 2014). Nevertheless, ensuring safe and quality care requires essential general competencies such as an autonomous, reflective, and independent holistic approach (Franco & Perán, 2014; Nilsson & Lindström, 2017; Oliveira & Martins, 2013; Ordem dos Enfermeiros, 2018) and personal competencies that respect intrinsic ethical and cultural aspects (Franco & Perán, 2014; Oliveira & Martins, 2013).

Domains (D), competencies (C), and related essential aspects.

Figure 1.

Domains (D), competencies (C), and related essential aspects.

The definition of the nursing professional as the “specialist in empathy” in the prehospital care team (López & Alvarez, 1995) shows the importance of interpersonal competencies, which include nontechnical communication skills, helpful relationships, leadership, and teamwork (Aftyka et al., 2014; Franco & Perán, 2014; Oliveira & Martins, 2013; Sjölin et al., 2015; Suserud, 2005; Wihlborg et al., 2014).

In addition, an effective prehospital emergency nursing practice inevitably involves the management of methodological competencies, such as clinical judgment and decision-making competencies (Andersson et al., 2014; Nilsson & Lindström, 2017; Sjölin et al., 2015; van Schuppen & Bierens, 2011; Wihlborg et al., 2014), essential in a responsive practice and in the elaboration or application of the nursing processes (Franco & Perán, 2014); or in the development of clinical guidelines to conduct interventions and measure their efficacy (Ordem dos Enfermeiros, 2018; Suserud, 2005; Tarragó & Sánchez, 2007).

The above-mentioned competencies are complemented by organizational competencies, the planning and management of situations and patients, the production of nursing records and reports, and teaching competencies of professionals, patients, and families through health education programs (Andersson et al., 2012; Franco & Perán, 2014; Nilsson & Lindström, 2017; Sjölin et al., 2015; Suserud, 2005; Wihlborg et al., 2014).

Finally, competencies determined directly by the work context are considered to be those related to the specific characteristics of the prehospital environment and the provision of material and personnel (as well as the risks deriving from the position that influences personnel safety, with regard to compliance with legislation) (Franco & Perán, 2014; Oliveira & Martins, 2013; Sjölin et al., 2015; Wihlborg et al., 2014).

The heterogeneity in the delimitation of the professional role also involves the heterogeneity in the specific training. Recently, the various training profiles have been classified in four groups in prehospital nursing in Europe (Vazquez-Casares & Vidal, 2019). The nursing degree and postgraduate degrees are regulated at the European level by the Qualifications Frameworks in the European Higher Education Area (QF-EHEA), establishing the degree of Doctor (PhD) as the maximum level (Level 8). In Spain, it is specified in the Marco Español de Cualificaciones para la Educación Superior (Figure 2).

Educational itineraries to train as a prehospital emergency nurse in Spain. Note. QF-EHEA = Qualifications Frameworks in the European Higher Education Area; MECES = Marco Español de Cualificaciones para la Educación Superior.

Figure 2.

Educational itineraries to train as a prehospital emergency nurse in Spain. Note. QF-EHEA = Qualifications Frameworks in the European Higher Education Area; MECES = Marco Español de Cualificaciones para la Educación Superior.

Although in several countries, including Spain, the lowest degree required is that of RN (Axelsson et al., 2016; González et al., 2014; Ordem dos Enfermeiros, 2018; Suserud, 2005), analysis of prehospital nursing training in Europe shows that the nursing degree alone is insufficient to effectively discharge the responsibilities of the position (Andersson et al., 2014; Griffin & Melby, 2006; Henrik & Kerstin, 2009; Marr et al., 2003; Oliveira & Martins, 2013; Rodríguez et al., 1998; Sjölin et al., 2015). In some countries, professional training has increased to achieve the accreditation of work through a postgraduate education program, expert, or master's program (Aftyka et al., 2014; Miller Wilson, 2011), continuing education (or complementary training), and even through the accreditation of work experience in critical care areas (van den Berg et al., 2014; van Schuppen & Bierens, 2011).

Guarantees of competence in prehospital emergency nursing are not only ensured by the operational definition of the competences, but also demand the establishment of the necessary levels of mastery and training required for acquiring these competencies.

The European guidelines (Declaration, 2020) state that competency-based training requires prior knowledge of the specific competencies assigned to the role and that the learning outcomes proposed are directly applicable to future work situations. Only in this way can we respond to the universities' call for orientating training toward effective performance in the specific labor, cultural, and social context, thereby achieving a better alignment between training and employment (Ortega et al., 2015). For this reason, we consider that a fundamental element in the identification of the competencies of a specific position should be the opinion of university professors because they are responsible for the design of curriculum programs of future professionals and for ensuring that the skills acquired in training correspond to the skills assigned to the specific professional role.

Therefore, the objective of this study is to describe the level of importance attributed by educators and trainers from Spanish universities in emergency nursing on the competencies of the position of prehospital emergency nursing and their opinion on the most appropriate level of training required to achieve such competencies.

Method

Participants and Procedure

This survey was performed through the use of an online questionnaire. The procedure for the selection of participants consisted of a search in the web pages of Spanish universities (public and private) in which the Degree in Nursing or Official Master's Degree, or the university's own titles relating to emergency nursing, emergencies, catastrophes, or critical care are awarded, according to the data provided in the Register of Universities, Centers and Qualifications of the Spanish Ministry of Education, Culture, and Sport. Subsequently, the teaching guides published for the academic year 2018–2019 were reviewed for those subjects included in the curricula in which the terms “urgencies and/or emergencies,” “urgent care,” “critical care,” or “life support” were included in the title or which included among their competencies or contents “basic and/or advanced life support.” A total of 443 individuals from 53 universities in 16 autonomous communities were located. Of the 443 individuals, 387 were contacted by email and sent a link to the online survey. Twenty-seven individuals responded that they did not consider themselves to be relevant to the content of the study. A response was obtained from 110 individuals (30.6%). All those who answered the questionnaire received clear information about the study and gave their consent for their questionnaire to be included in the study. The results section describes in detail the final participants in the study and provides information on their validity.

Instrument

The data were collected through a questionnaire developed on an ad hoc basis by the researchers, which contained the competencies for emergency nursing care in the 10 different European countries: Spain, Italy, Portugal, Cyprus, Turkey, Poland, Sweden, Finland, Norway, and The Netherlands, as found in the literature review. All the competencies included have been described as such in the review of the academic and professional literature.

The questionnaire consisted of 60 competencies distributed over 10 domains (Figure 1). The respondent was asked to assess the level of importance he or she attributed to each of the competencies proposed for the effective performance of the prehospital emergency nursing position in Spain, using a Likert scale from 1 to 5 in which 1 = no importance (not necessary, not useful), 2 = minor importance (not necessary but may have some usefulness), 3 = moderate importance (not necessary but complementary), 4 = very important (required), and 5 = total importance (essential). Respondents were also asked to indicate at what level of training they considered each proposed competency should be acquired (nursing degree, postgraduate, or complementary training) by means of a multiple choice question, which allowed the training levels to be combined and not mutually exclusive. Postgraduate training included the official master's degree, either the university's own master's degree or specialty type, and complementary training included that provided by scientific societies, welfare centers, and/or collegial or union organizations.

Analysis

Data analysis was performed with SPSS® software (version 24.0). The level of importance given to the specific competencies, and the opinion on the most appropriate level of training for their acquisition, was analyzed with descriptive statistics (frequencies and percentages). A k-means cluster analysis was conducted to propose a catalog of specific competencies classified for each training level through the different combinations obtained.

Results

Overall, 110 individuals (30.6% of those invited to participate in the study), belonging to 47 universities, answered the questionnaire. We have information from all the Spanish autonomous communities with the exception of Cantabria (16 of the 17). Ninety-eight professors are nurses, eight are physicians, and four have another degree. Fifty-nine are women and 51 are men. The average age is 46.5 years; the minimum age was 26 and the maximum was 69 years.

The most frequent profiles of the informants were a female nurse with an age between 31 and 35 years and a male nurse age 41 to 45 years, who had been trained in emergency care at levels above degree (only 9% did so at the degree level), and who currently teach exclusively at the degree level (40.9%) or at all three training levels simultaneously (22.7%).

The data relating to teaching work experience by the respondents can be seen in Table 1. From the results, it is noted that 49 respondents have a teaching experience of more than 5 years in emergency nursing in the field of care, 36 professors have more than 10 years of experience in intrahospital emergency, and 27 professors in the pre-hospital setting.

Teaching and Assistance Work Experience in Emergencies (in Frequency of Individuals)

Table 1:

Teaching and Assistance Work Experience in Emergencies (in Frequency of Individuals)

Level of Importance Attributed to Domains and Competencies

The global average of competencies, resulting in an average of global importance attributed to competencies was 4.47 of 5 points.

The evaluation of each of the competencies was obtained from the average of the evaluation attributed by 110 respondents to each of the 60 competencies. All the proposed competencies obtained values higher than 4.00 except C10 (Design care plans) and C34 (Uses diagnostic or therapeutic means [x-ray], with 3.79 and 3.54 points, respectively. The averages obtained for each competency are shown in Table 2.

Importance Attributed to the Proposed Competencies, Ordered by DomainImportance Attributed to the Proposed Competencies, Ordered by Domain

Table 2:

Importance Attributed to the Proposed Competencies, Ordered by Domain

The level of importance attributed to each proposed domain is determined through the arithmetic mean resulting from the mean attributed to the competencies that make it up and is shown in Figure 3. This mean is called the domain mean. The arithmetic mean obtained from each of the domains is 4.43.

Level of importance attributed to domains (D) (mean ± standard deviation). Note. D01: General competencies (C) (C01–C06); D02: Methodological competencies (C06–C11); D03: Technological competencies (C12–C15); D04: Interpersonal competencies (C16–C25); D05: Personal competencies (C26–C27); D06: Technical competencies (C28–C46); D07: Organizational competencies (C47–C49); D08: Teaching competencies (C50–C53); D09: Position-specific competencies I (C54–C56); D10: Position-specific competencies II (C57–C60).

Figure 3.

Level of importance attributed to domains (D) (mean ± standard deviation). Note. D01: General competencies (C) (C01–C06); D02: Methodological competencies (C06–C11); D03: Technological competencies (C12–C15); D04: Interpersonal competencies (C16–C25); D05: Personal competencies (C26–C27); D06: Technical competencies (C28–C46); D07: Organizational competencies (C47–C49); D08: Teaching competencies (C50–C53); D09: Position-specific competencies I (C54–C56); D10: Position-specific competencies II (C57–C60).

The domains with the highest score in importance were the domain D01 (4.58) relating to General Competencies and the domain D05 (4.58) relating to Personal Competencies. Those that were considered less important were the domain D08 relating to Teaching Competencies (4.29) and the domain D03 relating to Technological Competencies (4.23) (Figure 3).

General Competencies: Domain D01

This domain is composed of five competencies related to the provision of quality care. Together with domain D05, they obtained the highest level of average importance with a mean domain score of 4.58, above the global mean score for all competencies (4.47) and above the global mean score for domains (4.43).

The competencies to which university professors have attributed the greatest importance were C01 (Provides quality health care), which was also the second most important competency among all 60 competencies catalogued, with a score of 4.85, and C03 (Provides care from a patient safety approach), with 4.76. The other three competencies, C05, C03, and C04, relating to being reflective, providing care from a safety point of view, and autonomous and independent performance, respectively, scored below 4.58 (average score for the domain).

Methodological Competencies: Domain D02

Domain D02 is composed of six competencies related to the theoretical and methodological foundation of the nursing profession. The level of importance attributed to the competencies that make up this domain was 4.34, which is 0.13 points below the global average score of competencies and 0.10 points below the global average score for domains.

The most valued competency in this domain was C09 (Applies action guidelines or protocols), with a score of 4.75. To this competency is added a high importance to competency C07 (Possesses and applies expert clinical judgment), with 4.64, and C06 (Uses theoretical knowledge for complex decision making), with 4.61. Both competencies were above the domain average score (4.34) and above the global average score (4.47). Competencies related to the implementation and design of care plans get lower ratings. C10 (Design care plans) was the second least important competency (3.80), far below the overall average score for the domain. The competency C8 (Applies the nursing process) barely exceeds a score of 4.00 (4.09).

Technological Competencies: Domain D03

The four informational competencies that make up domain D03 are related to the effective management of information, the application of new technologies in research and in the evaluation and development of lines of research. It was the domain that obtained the lowest average score (4.23). The competency considered the most important was C13 (Applies research results in practice) (4.40). In contrast, the least valued competency was C14 (Promotes lines of research) (4.04).

Interpersonal Competencies: Domain D04

Domain D04 consists of 10 competencies focused on effective communication skills within the team, the patient and the family, and effective teamwork. The average importance score of D03 was 4.53.

Although the global evaluation of the domain places it as the third most valued, only four of the 10 competencies (C17, C22, C21 and C18) were valued above the global average of competencies (4.47). These are explicit competencies relating to teamwork and effective communication. C17 (Establishes effective communication) and C22 (Has a cooperative attitude with the rest of the work team) received a rating of 4.81, which places them in third and fourth position in order of importance attributed to the 60 competencies evaluated.

Personal Competencies: Domain D05

This domain consists of only two competencies related to ethical and cultural aspects. The average importance attributed was 4.56 for C26 (Possesses consistent attitudes in ethical decision-making) and 4.59 for C27 (Provides care based on ethical and cultural principles), which generates an average score for the domain of 4.58 and positions it, together with D01, as the two most valued domains in terms of importance.

Technical Competencies: Domain D06

The domain D06 is the one comprising the most competencies, being 19 in number. These competencies are related to the provision of specific nursing care and procedures. The average importance of the domain was 4.54, which places it in third place among all the domains studied.

This was the domain in which the greatest differences were observed between competencies. This domain included the competency that obtained the highest score of attributed importance, C37 (Recognizes vital risk and knows how to execute basic and advanced life support maneuvers) (4.87), and the competency that was considered the least important, C34 (Employs diagnostic or therapeutic means [x-ray]; 3.54). In addition, it includes competencies with very high scores (above 4.70) such as C40 (Performs the mobilization and immobilization of the wounded), C28 (Knows the physiological processes and mechanisms of injury), C29 (Knows the health alterations and their clinical aspects), and C38 (Performs advanced airway management) which have received average scores of 4.77, 4.75, 4.75, and 4.71, respectively.

Organizational Competencies: Domain D07

The domain D07 includes three competencies related to resource and situation management and to the production of data records. It has an average value of 4.41. All competencies proposed in this domain are below the overall average of competencies (4.47).

Teaching Competencies: Domain D08

D08 is composed of four competencies related to the training of other professionals and health education in general. The average importance score for the domain was 4.29, placing it in the second least important domain. Only C53 (Advises other professionals. Trains future nurses) surpasses the global average of competencies, with a score of 4.55.

Position-Specific Competencies I: Domain D09

The domain D09 is made up of three competencies related to the prevention of occupational risks. The average importance for the domain is 4.37, and none of the three competencies proposed in this domain reaches the overall average score of competencies.

Position-Specific Competencies II: Domain D10

The last four proposed competencies refer to the specific aspects of the prehospital context. The average importance attributed to the domain is 4.45. The competency considered most important in this domain is C60 (Requirement for ongoing professional training and updating), with an average of 4.77, which is in fifth position in relation to the 60 competencies proposed.

Most Appropriate Training Level to Address Competencies

The analysis of the dendogram obtained from a hierarchical cluster analysis allowed the identification of three groups as the most appropriate grouping for the 60 competencies. It should be noted that the data obtained do not meet the conditions for an exploratory factor analysis, which could offer more information. These three clusters clearly correspond to the three levels or types of training: nursing degree, master's degree, and complementary or continuing training. In the analysis, it has been possible to verify that the C14 competency (Promotes lines of research) is not included in any of the three clusters found. The k-means conglomerates analysis reveals that there are domains in which the competencies that are included in them belong entirely to a single conglomerate, such as domains D01 and D03 to conglomerate 1, D05 to conglomerate 2, and D10 to conglomerate 3. The competencies that make up the rest of the domains proposed draw a double training perspective and simultaneously encompass competencies to be acquired in postgraduate education, or through a combination of degrees and complementary training. There is no domain in which the competencies are present in the three clusters (Table 3).

Assignment of the Competencies Analyzed to the Conglomerates Obtained

Table 3:

Assignment of the Competencies Analyzed to the Conglomerates Obtained

The first conglomerate includes competencies in which the nursing degree is considered as the most appropriate training level to acquire them. The second conglomerate includes competencies that should be acquired at the postgraduate level; however, value is also attributed to complementary training as a valuable asset. This group includes 25 of the 60 competencies, which are related to the design and development of guides and protocols, acting as an expert and executing leadership, and the organizational skills of management of resources and changing situations. It also includes technical skills considered to be advanced and/or proper, prehospital care such as the management of specific equipment, the diagnosis and treatment of complex lesions in situ, triage skills, and disaster or catastrophe care. Finally, this group includes the advisory and training competencies of future professionals and those related to the specific risks of the prehospital nursing position, including the handling of situations of violence toward health personnel. Complementary training has been indicated in some cases as a level that can enrich the competency acquired in the postgraduate course, although in the case of technical and organizational competencies no respondent indicated that this training level was adequate to acquire these competencies in an exclusive way. The third group includes the need to combine at least two training levels to achieve effectiveness in the competencies and includes competencies that, although initially addressed in the nursing degree, require complementary training for effective performance. It groups 26 competencies related to the application of protocols and care plans and the design of care plans, communication skills and teamwork, and all competencies related to ethical and cultural principles. The technical competencies included in this conglomerate are mostly generalist competencies, such as data collection, diagnosis and treatment of minor injuries, administration of medications, and maintenance of hygiene conditions. The rest of the competencies belonging to other domains, such as nursing records and reports and the application of work ergonomics, are included in this group, although they are of a general nature, needing a specific approach in the prehospital setting.

Discussion

The coverage by universities and autonomous communities is almost total and the response rate to the questionnaire is the usual for this type of study (Andersson et al., 2014; Franco & Perán, 2014; Henrik & Kerstin, 2009; Wihlborg et al., 2014) this allows us to state that the results offer an adequate representation of the opinion of university professors linked to emergency nursing in Spain.

The results obtained allow us to affirm that all the competencies proposed have a high degree of importance in the performance of the role, highlighting that only two of the 60 competencies (C34 and C10) are valued below an importance score of 4.00 (of a possible 5). Therefore, we consider that the proposed catalogue is specific to the desired competencies for prehospital emergency nursing and that it reflects the breadth, complexity, and specificity of the position (Franco & Perán, 2014; Sjölin et al., 2015; Wihlborg et al., 2014).

In addition, the results obtained are in line with results previously published (Andersson et al., 2012; Andersson et al., 2014; McCarthy et al., 2013; Sjölin et al., 2015; Wihlborg et al., 2014) and show that, in the opinion of those responsible for teaching emergency nurses in Spain, even though the nursing degree is the minimum legal requirement for providing prehospital emergency nursing care, the acquisition of the competencies provided by the degree for a general nurse is insufficient for effective performance. The results obtained indicate which competencies described for a general nurse at the end of the nursing degree (Orden CIN/2134/2008) are sufficient for the performance of prehospital emergency nursing and which competencies should be addressed in the other training levels analyzed.

The fact that only eight of the 60 competencies proposed were considered as part of a nursing degree leads us to mention that if the nursing degree is to concentrate on training competent general nurses, other more specific competencies should be taught on other training levels. This would give more importance to the postgraduate and complementary training making them essential levels to acquire the specific competencies for the prehospital emergency nursing post. Postgraduate training is the level indicated by Spanish professors as adequate to acquire competencies related to critical thinking, leadership, and technical skills, encountered in the prehospital environment. These results can be interpreted as the need to address specific content in an academic postgraduate or clinical specialty that adapts the training to the specificity of the position. The appearance of a third conglomerate, in which the need to combine at least two training levels—nursing degree and complementary training—to achieve effectiveness, supports the thesis of Henrik and Kerstin (2009) that certain competencies require learning throughout life and can therefore only be acquired through experience-based learning.

The greater importance attributed by university professors to the domains of general and personal competencies, rather than to the domain of technical competencies, differs from the unquestionable importance attributed to the domain of technique over the rest, as presented in other studies (Andersson et al., 2012; Sjölin et al., 2015; Suserud, 2005; Wihlborg et al., 2014). This result shows the need to include other competencies in the nursing degree training, such as “Providing quality health care” and “Providing care that guarantees patient safety,” which are considered essential both by universities and by health care practitioners (Wihlborg et al., 2014), as well as being required by Spanish legislation (Orden CIN/2134/2008).

Even though the legislation stipulates the need to “Know and apply the theoretical and methodological foundations and principles of nursing” (Orden CIN/2134/2008), the professors from Spanish universities feel a preference for the application of clinical guidelines, as a theoretical foundation guaranteeing safe and quality practice, accompanied by a deep level of knowledge and the application of clinical judgment in decision making; categorizing competencies related to care plans is useful, but not essential. This discrepancy may be due to the fact that the required speed of action tilts the balance toward decision making supported by standardized and more readily applicable performance algorithms, as opposed to the more laborious individualized decision-making process advocated by care plans. However, the lack of information and results from other studies that address this issue suggests the need to be cautious in our claims and to continue research along these lines. Respondents attribute a higher level of importance to possessing and applying clinical judgment than to the use of theoretical knowledge for complex decision making and agree with other authors (Nilsson & Lindström, 2017; Sjölin et al., 2015) that clinical judgment competency is an essential element for postgraduate training.

The importance attributed by professors to competencies related to research may be striking, starting from an awareness of the importance of research and its direct relationship with a practice based on scientific evidence (Meretoja et al., 2004; Oltra-Rodríguez et al., 2013; Ordem dos Enfermeiros, 2018; Tarragó & Sánchez, 2007). The possibility that the low importance attributed to this is motivated by the intention of reserving the management of research competencies to the academic levels of PhD and not so much to the professional sphere is not sustained given that professors indicate the competency to apply research results in the nursing degree cluster, and the rest of the informational competencies are considered areas for nursing degree and complementary training. This suggests that these competencies are sensitive to lifelong learning and shows the importance of ongoing professional training and updating.

The high and equivalent level of importance attributed by professors to interpersonal and technical competencies increases the recognition of the high level of nursing competence in nontechnical skills and its recognition as part of a professional qualification (Henrik & Kerstin, 2009; Nilsson & Lindström, 2017; Suserud, 2005; Suserud & Haljamae, 1997; Wihlborg et al., 2014). In Europe (Sjölin et al., 2015), the limited space given to effective communication and teamwork competencies in postgraduate curricula is justified by the emphasis given in undergraduate studies. However, Spanish professors consider that their mastery is not achieved exclusively in the nursing degree, and complementary training is required for their acquisition. Continuous training throughout professional lives is required to enable practitioners to respond effectively to the demands of everyday practice.

In relation to technical competencies, our results again coincide with other studies on the importance attributed to competencies such as prescribing and administering drugs (Sjölin et al., 2015; Suserud, 2005) and diagnosis (Suserud, 2005; van Schuppen & Bierens, 2011). Respondents attribute a high level of importance to competencies such as identifying health changes through comprehensive assessment, performing diagnoses, and treatment of minor injuries. However, when it comes to major injuries, nurse competence in diagnosis and treatment decreases, which reinforces the results of van Schuppen and Bierens (2011) that the level of nurse competence was determined by the complexity of the therapeutic intervention required, as well as the results of Wihlborg et al. (2014), which place the importance of diagnosis of patients in the last position among all competencies analyzed.

The differences obtained in relation to teaching and organizational competencies (Suserud, 2005; Wihlborg et al., 2014) point to a need to analyze whether the low value attributed by professors to teaching and the production of reports and resource management, is a reflection of the prioritization of other competencies involved in the resolution of critical states; this either suggests complementary training is performed in the external clinical environment of universities, or perhaps little importance is given to these functions in prehospital nursing.

The overlapping results concerning context-specific competencies (Sjölin et al., 2015; Wihlborg et al., 2014) reinforce the need for adaptation by the professional to the specific environment and the need for continuous adaptation and lifelong learning to maintain the levels of competence required.

Limitations

The opinions of the importance attributed to each competency by the professors surveyed are, by definition, subjective and the direct experience of respondents working in different fields will have influenced their responses. In addition, the inventory is based on the reviewed literature (van Schuppen & Bierens, 2011), which implies that not all the competencies of nurses have been included and that there are other competencies not analyzed because they were not mentioned in the data sources studied.

Future lines of research will be aimed at comparing these results with the opinion of other nonteaching professionals.

Conclusion

This study analyzes the specific competencies of emergency nurses in the prehospital setting, according to the opinions of Spanish university professors.

The proposed competencies correspond to the specific competencies required in prehospital emergency nursing, to be competent (understood as deploying effective execution or performance), and is considered as a useful guide in informing the training curriculum of these professionals. This highlights the importance of the technical competency of “Recognizing the vital risk and knowing how to execute basic and advanced life support maneuvers” (C37). It also emphasizes the importance of the competencies related to quality care and the interpersonal skills of effective communication and teamwork as essential components of the curriculum.

In relation to the distribution over the curriculum, the need for specific postgraduate training for the acquisition of the majority of specific competencies is evident, keeping the acquisition of specific competencies and technological or informational competencies to the postdegree level. It corresponds to the academic postgraduate course or specialty and covers the training in specific advanced practice competencies, teaching, and those competencies related to the specificity of the context; complementary training addresses methodological competencies and interpersonal issues, and it addresses technical competencies that are not covered sufficiently at the degree level.

Although further studies are required, these results will be useful for professionals themselves, as well as academics and educators, in the planning of specific training programs for emergency nursing professionals, with the inclusion in the training curriculum of each one of the competencies, at the indicated level, so that training is always tailored to the requirements of the work positions held by the trainees. The next step consists of the development by Spanish professors of the tools to measure the level of acquisition of specific skills.

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Teaching and Assistance Work Experience in Emergencies (in Frequency of Individuals)

Scope< 2 Years2 to 5 Years> 5 to 10 Years10 YearsTotal
Teaching26163449110
Intrahospital setting261983689
Prehospital setting1513102764

Importance Attributed to the Proposed Competencies, Ordered by Domain

DomainaCompetencyMeanbSD
D01C01 - Provides quality health care4.850.40
D01C02 - Provides integral attention from a holistic approach4.450.77
D01C03 - Provides care from a patient safety approach4.760.49
D01C04 - Plays its role autonomously and independently4.290.80
D01C05 - Is a reflective professional in procedures, situations, and the profession itself4.520.67
D02C06 - Uses theoretical knowledge for complex decision making4.610.61
D02C07 - Possesses and applies expert clinical judgment4.640.55
D02C08 - Applies the nursing process4.090.95
D02C09 - Applies action guidelines or protocols4.750.48
D02C10 - Designs care plans3.791.06
D02C11 - Designs action guides or protocols4.190.84
D03C12 - Applies information and communication technology and communication systems4.310.79
D03C13 - Applies research results in practice4.400.83
D03C14 - Promotes lines of research4.040.97
D03C15 - Establishes the evaluation mechanisms4.190.86
D04C16 - Identifies the psychosocial responses of victims or patients4.520.60
D04C17 - Establishes effective communication4.810.50
D04C18 - Establishes empathic communication4.690.55
D04C19 - Performs a role of help or information to the patient or family4.540.69
D04C20 - Performs effective radio communication4.011.09
D04C21 - Works effectively as a team4.790.49
D04C22 - Has a cooperative attitude with the rest of the work team4.810.48
D04C23 - Actively participates as an expert4.400.78
D04C24 - Exercises leadership4.300.79
D04C25 - Collaborates with other work teams (hospital teams, primary care, and security forces)4.410.81
D05C26 - Possesses consistent attitudes in ethical decision making4.560.71
D05C27 - Provides care based on ethical and cultural principles4.590.71
D06C28 - Knows the physiological processes and mechanisms of injury4.750.49
D06C29 - Knows the health alterations and their clinic aspects4.750.46
D06C30 - Ensures hygienic handling of the victim4.650.60
D06C31 - Manages specific ambulance equipment4.550.74
D06C32 - Performs victim/patient data collection4.470.73
D06C33 - Identifies health needs through comprehensive assessment4.500.77
D06C34 - Employs diagnostic or therapeutic mean (x-ray)3.541.21
D06C35 - Performs triage or prioritization of victims4.600.79
D06C36 - Performs specific advanced practice techniques and procedures4.620.65
D06C37 - Recognizes vital risk and knows how to execute basic and advanced life support maneuvers4.870.53
D06C38 - Performs advanced airway management4.710.63
D06C39 - Performs the diagnosis of arrhythmias and their electrical treatment4.580.71
D06C40 - Performs the mobilization and immobilization of the wounded4.770.54
D06C41 - Establishes diagnosis, treatment, and follow up of minor injuries4.420.84
D06C42 - Establishes diagnosis, treatment, and follow up of more complex lesions4.270.82
D06C43 - Medication management (administration and/or prescription)4.630.69
D06C44 - Performs in situ treatment4.570.74
D06C45 - Pays attention to disasters and/or catastrophes4.520.79
D06C46 - Pays attention to gender-based violence4.550.73
D07C47 - Manages care resources effectively and makes an appropriate referral of the patient4.320.74
D07C48 - Effectively manages changing situations4.450.67
D07C49 - Performs nursing records and reports4.460.75
D08C50 - Provides advice within the global health system4.020.83
D08C51 - Provides advice within the emergency area4.230.82
D08C52 - Performs patient and family counseling. Provides health education and health promotion4.360.85
D08C53 - Advises other professionals. Trains future nurses4.550.63
D09C54 - Detects and manages workplace risks4.420.71
D09C55 - Applies work ergonomics4.260.79
D09C56 - Manages situations of danger or violence against health personnel4.420.71
D10C57 - Knows the physiopathology of health transport (land, air or sea)4.320.85
D10C58 - Knows the specific legislation and regulations applicable to the health field in which it is located4.170.85
D10C59 - Knows the specific organization of the emergency system4.520.63
D10C60 - Requirement for ongoing professional training and updating4.770.46

Assignment of the Competencies Analyzed to the Conglomerates Obtained

ConglomerateDomainaCompetencies
01: Initial training or degreeD01C01, C02, C03, C04, and C05
D03C12, C13, C14, and C15
02: Postgraduate trainingD02C07 and C11
D04C20, C23, C24, and C25
D06C31, C34, C35, C36, C38, C42, C44, and C45
D07C47 and C48
D08C50, C51, and C53
D09C54 and C56
D10C57, C58, C59, and C60
03: Longitudinal training (various levels and degrees)D02C06, C08, C09, and C10
D04C16, C17, C18, C19, C21, and C22
D05C26 and C27
D06C28, C29, C30, C32, C33, C37, C39, C40, C41, and C43
D07C49
D08C52
D09C55
Authors

Ms. Vázquez-Casares is Nurse, Department of Nursing and Physiotherapy, and Dr. Vidal is Professor, Department of Psychology, Sociology, and Philosophy, University of León, León, Spain.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Ana Vázquez-Casares, PhD, MSN, RN, Nurse, Departamento de Enfermería y Fisioterapia, Universidad de León, Campus de Vegazana, S/N 24401 León, Spain; email: ana.vazquez@unileon.es.

Received: February 05, 2020
Accepted: June 17, 2020

10.3928/00220124-20201113-06

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