From 21participants,15 were female and 6were male. Their age range was27-55years, with a mean age 42.35±10.8 , mean teaching experience 4.3 ±1.9 , clinical experience 3.5±1.6. Based on content analysis, one of themes was meta-competency which extracted from "thinking and clinical reasoning skills", "dynamic learning", research and evidence based practice", "human and organization management". Each category has several subcategories(diagram 1).
1- Thinking and clinical reasoning skills: The first dimension is thinking and clinical reasoning which is "holistic perspective", "critical and creative thinking", and "clinical decision making". Student must consider all effective factors on health of client and family based on holistic perspective, critically analysis challenging situations, seek creative solution and intervention, solve problem with proper decisions, according to scientific reasoning take care client and family. Nurses with scientific reason will be able to assess factors affected on health, deal with, solve problem by properly intervening. Clinical reasoning empowers nurses in decision making.
1-1 Holistic perspective.
Holism is one of the principles of thinking skills and clinical reasoning that psychiatric nursing students should plan their interventions by considering all inseparable and effective components on the client's health. Participants believed that the MSc psychiatric nurse student did not learn holistic skills only with direct education, but it is learned in the clinical environment. Most of the psychiatric nurses emphasized holistic view, for example, participant number 2 stated:
".. That's not what we tell the student. That's what he has to learn in the workplace. Then he/she him/herself will come to touch it. We just teach to watch various aspects of things. whether student really make the right decision or not ,I don't know..."
1-2: Critical and Creative thinking:
The majority of participants emphasized on the necessity of addressing critical and creative thinking in the education of postgraduate students and believed that awareness of the details of the problem and evaluation of multiple decisions before doing, and finally solving the problem requires critical and creative thoughts. As each patient has its own needs, nursing care needs unique creative solutions that cannot be learned by cliché training. Also, just critically thinking is not enough for nurses, but they should implement the thoughts in practice. Therefore, the M.Sc student of psychiatric nursing in order to perform nursing care should identify health affairs, situations, challenges and health problems with a blend of innovation, flexibility and support. They should analyze the information and design, implement and evaluate a creative care plan. Critical thinking increases the power of clinical decision-making in diagnosis of patient needs and selection of the best practices and nursing methods. The university faculty, with 20 years of experience, said: "... The skills of critical thinking.
"... Critical thinking skills. Problem solving skill. These are what they must learn and do over courtships of higher degree"(P. 14).
1-3. Clinical decision making.
Clinical decision making is one of the interventions and strategies that have an effect on the process of improving the patient's clinical condition. In particular, the psychiatric sections have many ethical challenges. Decision-making under uncertain conditions is dangerous and difficult. For example, a psychiatric student with 11 years of clinical experience stated:
"... I'm very sensitive about how decision-making in situation because, for example, I may see something new which hasn't been at all as yet, I may see some events new that I couldn't solve with my information. While I need to know. how to manage that . I would be able reason.... " (P. 9)
2. Dynamic learning. The second dimension is dynamic learning, extracted from "interest and motivation", "application of knowledge in practice" and "ongoing learning". Student interest in the field, interest in helping the patient, motivation to serve and promote the health of the client and society, result in providing compassionate nursing services and care, also the student constantly tries to improve his knowledge and update his scientific and professional information, and continuously learn. Participants believed that the post graduate student, in addition to his bachelor's degree in nursing, should have sufficient knowledge on health care, personality characteristics and normal/abnormal behaviors, and appropriate interventions to solve or decrease health problems . He is able to consciously apply his knowledge according to the conditions in practice. Often, the wider the knowledge, the more skills for application in the situation. So, The student is supposed to learn continuously.
1-2-.Interest and Motivation.
Participants believed that interest in the nursing profession, pleasure and satisfaction of helping fellow human beings were necessary for compassionate nursing care . They believed that it would not be possible for the patient without those . The student's disinterest to the psychiatric nursing profession will also bring tension and conflict of role.
The faculty said:
".. he should be enthusiastic to the patient. He accept psychotic patients as a person with mental disorder. Sometimes you see someone who has come to nursing, psychiatric nursing, but practically he doesn't like to work as a psychiatric nurse(P. 1)..."
2-2. The application of knowledge in the practice.
Psychiatric nursing students should be able to appropriately object the theoretical knowledge learned at the university, such as health knowledge and physical and mental disorders at different ages, specialized interventions of psychiatric nursing, medication and non-pharmacological treatments in the clinical. The faculty, with 13 years of experience, stated:
"I know that the practical psychiatric nurse has these two domains, i.e. he has a very strong scientific knowledge of all the diseases and should be able to bring in the clinical for his patient. To be able help in the treatment of his patient. The theories learned about the milieu therapy , the communication therapy .and so on for the mentally ill, a psychiatric nurse who is working in the department should be able to implement those for patient. In fact, scientific subjects."
Participants stated that the topics and headings of the educational program are incomplete also the knowledge gained during the 2-year master's degree course are not enough to become an expert in the profession. Besides, due to the complexity of the modern world, increasing diseases, changing care and treatments, the development of technology and information, students should constantly reevaluate their information for individual development. Psychiatric section supervisor mentioned: "…Curriculum is a bit incomplete. Psychiatric nursing care was studied over bachelor degree, but it isn't included therapeutic issues especially in clinical, for example MSc psychiatric nursing students are not taught on psychotherapy, CBT and its types. These would be useful(P13).
Participant nomber9 about ongoing learning said:
"... I feel I must keep knowing more. we should keep discovering more . Not satisfying in I hold Msc degree, so I know a lot! Somewhere I feel empty, I feel weak, then I go... exemplary to read an article, to ask for specialist..."
3. Research and Evidence-based practice. The third dimension for the meta-competency theme, are the research and evidence based practice. Participants believed that at the master's level, a variety of research methods and approaches were taught, as a result , students are expected to use the skills learned to solve the problems of the client, society, and to develop the knowledge of the psychiatric profession. Effective and novel therapeutic approaches were searched and are used as intervention source.
Participants considered different research methods as one of the skills learned at the master's level. Therefore, after assessing social environment needs, the student should research to solve the identified problem then, share the results with others. Thus, in addition to solving the problems of each community, it will update colleagues and expand the knowledge of psychiatric nursing.
The university faculty says, "in fact, as psychiatric nurse was taught about research articles and researching , definitely they are master at researching , they are familiar to translation, research and write article more. to Start writing articles about the environment where he's working on. Implement novel approaches of treatment, inventions related to psychiatry." (P. 12)
2.3. Evidence Based Practice.
According to the participants, one of the missions of psychiatric nurses is to update the information through studying and translating the latest scientific achievements and implementing scientific knowledge approved in the field of psychiatric nursing care. So, sharing knowledge gained results in expanding the knowledge of psychiatric nursing, developing the profession and improving the quality of care. The university faculty with 13 years of experience stated: ". to be able to read new articles, to translate new information. To be able to interpret and analyze it. To be able to train the new results found out for the personnel. He is going to use new methods, and he would applied a series of newer methods gained by translating of Article something (P. 12)
4. Human and Organization Management. Most of participants considered the role of Msc psychiatric nurses as controlling the aggressive patient in terms of self-harm or others, continuous supervision of patients, guidance, cooperation and quality control of the services by colleagues and medical teams.
1.4. Supervision and control of psychiatric patients.
Participants believed that methods of communication with aggressive patients, delirious thoughts or suicides are taught, but the art of proper use of different communication techniques and interventions appropriated to the patient and obtaining satisfactory results are not taught but they are obtained. On the significance of continuous monitoring and watching of psychiatric patients, the education supervisor of psychiatric setting and university faculty stated:
"I have to learn how to calm him down who is now agitated, not to make it worse myself."(P2)
2-4. Leadership and management of personnel and psychiatric section.
Some participants believed that master of psychiatric nursing who specializes in psychiatric nursing should supervise and direct the nursing care performed by other colleagues, and take over the management of the team. In this way, the quality of services increases by coherently carrying out care and intervention. The head nurse of psychiatry department with 28 years of experience in management stated:
"... generally Someone who earns a master's degree is hired him in the management ranks, as a mentor, or head nurse(P. 20),
Although some participants had the opposite belief and believed that only by passing two years of master's program, the student could not acquire managerial skills. Even maybe a nurse with bachelor degree would have a higher management skill which has been developed by gaining experience. Participant No 20 put it:
"... Of course, again, it is based on the efficacy. There's a time when this person's experience is so high that they won't let someone who's recently hold MSC gets replaced. Even if he/she had PhD degree. The psychiatric department has a lot of responsibilities, a lot of details in the psychiatric ward, so they don't put anyone in charge of the psychiatric department..."