gms | German Medical Science

Background: The majority of care-dependent persons living in nursing homes have mobility impairment which negative affects the physical and social aspects of the persons’ lives. Limited mobility also frequently leads to an increasing loss of autonomy and influences care-dependent persons’ general wellbeing. Research suggests that every fifth nursing home resident could reach higher level of independence in self-care activities, if mobility enhancing care is provided. Nursing staff are in a key position to provide mobility enhancing strategies while supporting care-dependent persons with their daily activities. Therefore, nursing staff requires competence (knowledge, skills and appropriate attitude). The comprehensive training approach kinaesthetics aims to develop this competence.

Aim and research questions: This study aimed to assess the self-reported and observed competence of nursing home staff in mobility care based on kinaesthetics. The following research questions were addressed:

1.

What is the level of self-reported competence in mobility care for nursing staff?

2.

What is the level of observed competence in mobility care for nursing staff?

3.

Which sociodemographic and professional characteristics of nursing staff are associated with higher self-reported and observed competence in mobility care?

Methods: A cross-sectional study design involving a survey and an observational study was employed in three swiss nursing homes. Survey data were collected using the Kinaesthetics Competence Self-Evaluation (KCSE) scale (sum score from 4 to 16, subscale score from 1-4). For the observational study, data were collected with a video camera and rated using the Kinaesthetics Competence Observation (KCO) instrument (sum score from 4 to 16, subscale score from 1-4). Data were analysed using descriptive statistics, correlation methods and a generalized linear model.

Results: From the nursing staff asked to participate in the survey (n=214), 180 returned the questionnaire (84.1%). The respondents’ mean age was 41.8 years. The mean work experience in nursing home care was 12.9 years. The majority were nurse assistants (46%), followed by registered nurses (33%) and licenced practical nurses (17%). The majority of survey participants indicated their competence in mobility care as very good (mean sum score 13, SD 1.44). Self-ratings were higher in the subscale attitude (mean score 3.6, SD 0.27) and dynamic state (mean score 3.4, SD 0.40) than in the subscale knowledge (mean score 3.0, SD 0.59) and skills (mean score 3.0, SD 0.50).

In the observational study 40 nursing staff members with a mean age of 39.1 years and a mean work experience in nursing homes of 10.0 years were included. Forty-one percent were nurse assistants, 36% registered nurses and 18% licenced practical nurses. The observed competence of nursing staff was good (mean score 10.8, SD 2.44). Observed competence was higher in the subscale nurses' movement (mean score 2.9, SD 0.62) than in the subscale interaction (mean score 2.7, SD 0.67), adaptation of environment (mean score 2.7, SD 0.69) and movement support of the care-dependent person (mean score 2.6, SD 0.65).

Positive correlations were found between self-reported or observed competence in mobility care and employment rate, work experience in nursing home care and kinaesthetics training.

Discussion: Competence in mobility care described in this study includes knowledge, skills, attitude and a dynamic state. Participants’ self-evaluated competence level may reflect a high awareness about mobility enhancing care among participants and an openness regarding a process of active participation in learning activities to enhance mobility care practices. On the other hand, the results of the external assessment (observation) showed that the mean competence level for skills was good, with nurses’ own movement showing higher ratings than interaction and adaptation of environment. The weakest ratings occurred for the area movement support of the person. An over-estimation of a self-evaluated assessment compared to an external assessment, e.g. observation, has been reported in previous research. The participants may have failed to realize their own areas of incompetence, due to a lack of self-awareness or blind spots.

Practical implication: The assessment of nursing staffs' competence in mobility care is an efficient way to determine areas that require further attention and training. Based on this assessment, the nurse management can take action regarding attitude and dynamic state in mobility care while kinaesthetics trainers can tailor the content of training courses to increase skills in mobility care. Since the self-assessment is subjective and “blind spots” may prevent nursing staff members from accurately reporting their strengths and areas for growth, the observation method should be used alongside the self-evaluation.