Exploring the Association of Perceived Interpersonal Competence in Nurses and Competency-Based Nursing Programs: A Mixed Methods Study

Abstract

Competency development of nurses starts at the pre-service level where students are instructed and supported to develop their clinical skills. In 2021, the American Association of Colleges of Nursing (AACN) called for the renovation of nursing education as an attempt to reduce the competency gap of new graduates and suggested Competency-Based Education (CBE) as a strategy educators can use to help bridge the gap between theory and practice. AACN identified ten domains for nursing practice with specific areas of competence, which provide a robust framework for CBE. One of the essential pillars identified by AACN for nursing practice is communication skills, which is an integral aspect for developing Interpersonal Competence (IC) in nurses. However, there is no research addressing the association of CBE and IC in new nursing graduates. Therefore, it is critical to assess the level of IC in nurses and the association between this level of competence and the type of education the nurses receive. This study explored the association between CBE versus traditional programs and IC of newly graduated nurses in Lebanon. An observational cross-sectional mixed methods study was conducted to explore the difference in IC between new registered nurses working in medical-surgical units, maternity units, adult critical care areas including intensive care units, respiratory care units, neurologic care units, coronary care units, and post-anesthesia units and graduated within the last 6-12 months from CBE programs and those who graduated from traditional ones. An exploratory sequential method design was used in which qualitative data were collected and analyzed first; then quantitative data was collected and used to test the study hypotheses regarding the association between the IC of novice nurses and the type of educational program they studied in, followed by individual nurses’ interviews to verify the survey results. Two phases of data collection were used. In the first phase, a desk review of four selected university programs in Lebanon was carried out using a checklist that was created based on the eight elements of the quality framework for CBE programs and the Hallmark practices in CBE Assessment that the CBE Network identified in 2021. Then, four focused group discussions (one from each university under study) were conducted with faculty members using an interview guide based also on the Hallmark practices in CBE Assessment to clarify and validate the results of the desk review. The results of Phase I were used to identify which of the four universities use the CBE approach. According to the results of Phase I, two nursing programs were considered emerging to developing CBE programs while the other two were considered traditional programs. In the second phase, nurses with BSN who studied in the selected programs, were surveyed using the Interpersonal Competence Questionnaires (ICQ) to assess their IC levels. Then, based on the results of the analysis of the Lime survey, semi-structured interviews with willing nurses were conducted to clarify the results of the survey that were not amenable to interpretation and required further explanation. The results of the ICQ lime survey of nurses revealed that in general new nurses had average to low IC scores. The comparison of IC scores between university groups indicated that there is no significant difference between the IC scores of the nurses who graduated from CBE programs and those from traditional ones. In addition, the tested sociodemographic and work-related variables did not significantly affect the total IC scores. The results of the six semi-structured interviews for nurses helped to foster a better understanding of the nurses’ opinions of why the IC scores were low. According to the interviewed nurses, the work environment, the crisis affecting the country, and university preparation of students for the transition from theory to practice are important factors that affect IC scores. This study provided baseline knowledge about the types of nursing education approaches used in Lebanon and the level of IC in new graduate registered nurses. This study has significant implications for future research, educational practice, and policy and regulations. It highlighted the gaps in curricula implementation, the need to train and develop the faculty members and preceptors involved in teaching nursing students, and the need to create and regulate a policy to assess and evaluate the effectiveness of the educational approaches used in teaching nursing students in Lebanon.