Competence Assessment Instruments in Perianesthesia Nursing Care: A Scoping Review of the Literature Yunsuk Jeon, MSc, RN, Riitta-Liisa Lakanmaa, PhD, RN, Riitta Meretoja, PhD, RN, Helena Leino-Kilpi, PhD, RN, FEANS Purpose: To identify competence assessment instruments in perianesthesia nursing care and to describe the validity and reliability of the instruments. Design: A scoping review in a systematic manner. Methods: A search in CINAHL, MEDLINE, and ERIC was carried out to identify empirical studies from 1994 to 2015. A narrative synthesis approach was undertaken to analyze the data. Findings: Nine competence assessment instruments in perianesthesia nursing care were identified. The instruments used three types of data collection methods: Self-report, observation, and written examinations. The most commonly reported validity method was content validity involving expert panels and reliability tests for internal consistency and inter-rater’s consistency. Conclusions: Integrating more than one data collection method may give support to overcoming some of the limitations, such as lack of ob- jectivity and misinterpretation of the assessment results. In an ever- changing environment, perianesthesia nursing competence requires constant reassessment from the perspective of content validity, scoring methods, and reliability. Keywords: competence assessment instrument, perianesthesia nursing care, literature review. Ó 2016 by American Society of PeriAnesthesia Nurses PERIANESTHESIA NURSING CARE is commonly Yunsuk Jeon, PhD Candidate, Clinical Researcher, MSc, RN, regarded as a nursing specialty concerned with Department of Nursing Science, University of Turku, Finland; providing nursing care to patients undergoing or Corporate Headquarters, Helsinki University Hospital, Hel- recovering from anesthesia. Internationally, in a sinki, Finland; Riitta-Liisa Lakanmaa, PhD, RN, Senior large umbrella of the perianesthesia specialty, peri- Lecturer, Department of Nursing Science, University of Turku, anesthesia nursing includes planning and caring Finland; Turku University of Applied Sciences, Turku, Finland; Riitta Meretoja, PhD, RN, Development Manager, for preanesthesia, intra-anesthesia, and postanes- Adjunct Professor, Department of Nursing Science, University thesia patients until the patient is discharged into of Turku, Finland; Corporate Headquarters, Helsinki Univer- a ward setting or home.1,2 Furthermore, sity Hospital, Helsinki, Finland; and Helena Leino-Kilpi, PhD, perianesthesia nursing care can be expanded RN, FEANS, Professor and Chair, Nurse Director (part-time), from the operating theater environment to Department of Nursing Science, University of Turku, Finland; Turku University Hospital, Turku, Finland. various clinical settings such as diagnostic, Conflict of interest: None to report. therapeutic, obstetrical procedures, and pain Address correspondence to Yunsuk Jeon, Department of management.1,2 In various environments, Nursing Science, University of Turku, Joukahaisenkatu 3-5, perianesthesia nurses are expected to be experts, 20014 Turku, Finland; e-mail address: yunsuk.jeon@utu.fi. to be able to make flawless and rapid judgments, Ó 2016 by American Society of PeriAnesthesia Nurses 1089-9472/$36.00 and to deal professionally with the ethical 2-4 http://dx.doi.org/10.1016/j.jopan.2016.09.008 issues. Therefore, they require a set of 542 Journal of PeriAnesthesia Nursing, Vol 32, No 6 (December), 2017: pp 542-556 PERIANESTHESIA COMPETENCE ASSESSMENT INSTRUMENTS 543 specialized knowledge and skills to satisfy the competence assessment instruments in perianes- complicated needs of a patient in perianesthesia thesia nursing care and to describe the validity care.1,5 and reliability of the instruments. International council of nurses defined competence Methods as ‘‘the effective application of a combination of knowledge, skill and judgment demonstrated A scoping review refers to a process of mapping or by an individual in daily practice or job perfor- summarizing the existing literature to understand mance.6’’ In the case of the United States of the range of the field.15-19 In this study, a scoping America, nurses in perianesthesia care periodically literature review methodology based on the take a certain number of supplementary courses, framework (five stages) outlined by Arksey and continuing education credits, or web-based O’Malley20 was undertaken to identify the litera- learning to maintain their certification.3,7,8 In ture available in the field of perianesthesia nursing Europe, there is no specific regulation for care. recertification of nurses in perianesthesia care and nursing training varies a great deal both nationally Stage 1. Identifying the Research Questions and internationally.9 Therefore, it is essential to pro- vide a more accurate assurance when evaluating A scoping review was carried out to answer whether a professional has achieved an acceptable following questions: level of knowledge and skills.10 1. What instruments were used to assess competence in perianesthesia nursing care? To provide safe care for patients and maintain the 2. How were the validity and reliability of the credibility of nurses by providing the capabilities assessment instruments reported in the liter- to correspond to dynamic circumstances, a system ature? of competence assessment in perianesthesia care is demanded. However, the competence assess- ment instruments currently used in perianesthesia Stage 2. Identifying Relevant Studies nursing education and practice may lack validity or reliability, or both. A competence assessment in- A literature search was carried out using the elec- strument developed by a valid and reliable process tronic databases, CINAHL, MEDLINE (Ovid), and would be beneficial for a more rigorous evaluation ERIC in September, 2015. Single and combined of the competence of nurses and enable the iden- search terms included: competen*, assess*, tification of deficiencies in professional develop- scale*, tool*, evaluat*, measure*, nurs*, peri- ment and educational needs.11-14 an(a)esth*, prean(a)esth*, intraan(a)esth*, postan(a)esth*, an(a)esthe*, PACU, perioper- To date, little information is available regarding ati*, preoperati*, intraoperati*, postoperati*, what competence assessment instruments exist recovery, valid*, and reliab*. To uncover any in perianesthesia nursing care, and how valid and additional publications or gray areas in the litera- reliable they are. Thus, comprehensive research ture, hand searching of reference lists for key arti- focusing on competence assessment in perianes- cles and a search using a general internet browser thesia nursing care as well as the validity and reli- (Google Scholar) was undertaken. The search ability of the assessment instruments is necessary. covered all countries, but only the English language For this purpose, a scoping review methodology from the last two decades (1994 to 2015) were has been conducted to provide an overview of included. During this period, nursing education the current literature related to competence assess- has been under reform in Europe and research con- ment in perianesthesia nursing care. cerning competence in nursing has increased.21 Purpose Stage 3. Study Selection The purpose of this review was to describe how For the study selection, the scoping review adop- competence in perianesthesia nursing care has ted similar methods to a systematic review. Refer- been assessed. The review aimed to identify ences were included if they measured any 544 JEON ET AL aspect of the scoping in relation to nurses’ compe- Stage 4. Charting the Data tence in perianesthesia care on the basis of the in- clusion criteria (Table 1). In the search, The charting of the studies provided an overview perianesthesia nursing care was operationally of the existing literature. A spreadsheet was defined as nursing care related to patients undergo- created to chart relevant data based on the focus ing procedures requiring sedation, analgesia, and of the scoping question (Y.J.). To identify the range anesthesia in the operating unit, anesthesia proce- of the study, 13 articles were summarized by the dural areas, or postanesthesia care units (PACUs). author with regards to year of publication, coun- try, purpose of study, design/sample/participant/ The initial search generated 232 research articles. ethics, instrument, and key findings. On the basis Two researchers (Y.J. and R.L.) independently re- of the summary of the data, competence assess- viewed and applied the selection criteria to all ti- ment instruments were identified and charted spe- tles and abstracts. During the title and abstract cifically by a data collection method, the domain/ screening process, references were marked as category (item), a scale/scoring, and the validity either ‘‘include,’’ ‘‘unclear,’’ or ‘‘excluded,’’ and the and reliability of the instruments. former two categories marked on the abstract screening were included for the full-text review. A scoping study tends to present broader themes After the titles (deletion of 132 references, which for which the various types of study might be did not meet the inclusion criteria based on the ti- applicable and is less likely to seek to assess the 20 tle) and abstracts (deletion of 71 references, which quality of the studies included. As a scoping did not meet the inclusion criteria based on the ab- study, this review did not conduct a quality stracts) of the articles were scrutinized, 19 articles appraisal process. Instead of a quality appraisal of remained