Background

During the last 10 years, globalization has brought the concept of "competitiveness" in high-quality, low-cost and safe patient health care to healthcare systems in Scandinavian countries.1,2 There has been an increasing focus on competitiveness in an effort to maintain welfare systems and wealth.1,3,4 At the same time, these healthcare systems also struggle with new challenges because of changing demography, an aging population and an increase in chronic diseases, comorbidity and lifestyle diseases.1,2 These challenges have prompted an increased focus on talent development in educational systems, the workforce and healthcare systems in Scandinavian countries.1,2,5 In the future, there will be a need for reflective health professionals who are able to balance different ethical, economic, political and professional concerns and to withdraw knowledge regarding, evidence, experience and patient perspective in the crossline between the different goals and means human science and natural science often create. These qualifications are particularly needed in primary health care.6

An example of the focus on talent development can be seen in the Danish report, "Complex future and reflective healthcare professionals,"6 prepared by representatives from trade unions in health care in Denmark. The report provides an examination of future trends and educational needs in health care, indicating that in the future, there will be an ever growing need for health professionals who can balance ethical, economic, political and professional considerations as well as integrate best evidence, their own experience and the patient's needs. It concludes that these qualities will be needed particularly in primary health care.6 Thus, the key question is: which kinds of talent can support the development of such qualities?

Research shows that the concept "talent" and the processes of "talent development" are highly influenced by culture, context and scientific approach.7,8 In the United States, concepts as "gifted" and "talent" are often used interchangeably, and the focus is mainly on children with a high intelligence quotient (IQ).9-11 In Europe, there is a tendency toward more broad definitions. Commonly, European research tends to separate two sorts of giftedness: the 1-2% of very bright children in a year group and the 10-15% of children with certain qualifications within one or more areas. The latter is most commonly defined as talent in the European research.9,12 Such an approach is very close to Gagnes'13 "differentiated model of giftedness and talent",13 where he recommends that talent development focuses on the transformation from outstanding natural abilities or gifts into outstanding systematically developed skills. Such systematically developed skills are defined as expertise or talent within a particular occupational field.13

In Europe, there is a tendency to draw on Gagnes'13 research theory and thereby define talent within the existence of: (i) certain qualifications within one or more areas, (ii) the will and motivation to make an extra effort, and (iii) the possibility of being "one of the best" if these qualifications are nurtured.9,13

Talent development programs are planned differently in different educational systems, but their purpose is more or less to systematically nurture the student's gifts/qualifications. Talent development programs implicate that not all students but only some, either chosen or selected, will be given extra educational activities to develop a certain gift/qualification.9,14 In the United States, the approach is progressive and systematic, for example, implementation of the "strength finder interventions" at all educational levels.15 In Europe, talent development programs are also implemented at different educational levels, for example, honors programs at higher educational institutions.9

One of the great challenges when it comes to talent development in Scandinavian countries is a strong egalitarian tendency found in the three countries' social-democratic traditions.9 In this tradition, equal opportunities for everyone, equity and equality are considered to be of high value. For example, this is reflected in the single-structured education model and in free admission to the educational system.9 One disadvantage of such an egalitarian tradition is the difficulty in generally accepting the premise of talent development as talent development processes will always be about identifying the "right persons" and about giving certain educational offers to them - and not to all.9 Despite these challenges, we now see a growing political focus on talent development in Scandinavia, and pressure is laid upon educational systems to work with talent development.2 When specifically looking at nursing education in Scandinavia, we see a three-and-half-year generalist education where specialization is not possible before graduation.14 According to the research of Wolfensberger,9 the honors programs in Europe mainly has an academic focus, and most often the aim is to qualify for a PhD. The rest of the honors programs in Europe tend to have a merely randomized focus, and no clear lines can be defined.9

What we see then is a call for talent development in all educational systems for healthcare professionals in Scandinavia, including nurse education. The main question is what kind of nursing talent are (or could be) needed in future healthcare systems? In other words, which areas should Scandinavian nursing education focus on when they plan talent development programs? What kind of talent does nursing education need to nurture?

To obtain an understanding of the needs for nursing talent in Scandinavian countries, it is necessary to look at the views of important stakeholders who have an interest and who influence nursing education in Scandinavia. The most important stakeholders in Scandinavian countries are:

* Politicians in the government who have an interest in the healthcare system and have power when it comes to educational decisions.

* Regional and local political organizations that are responsible for and play an important role in primary health care.

* Trade unions of nurses who are concerned about the interests of their future nurses.

* The private sector that has an interest in a workforce with innovative mindsets.

* Employees in the healthcare sector.

While the views of the above groups are significant, this review will focus solely on the views of trade unions and political stakeholders. Therefore, this review will not give a complete perspective of nursing talent needed for the future or the kind of talent nursing education that should be nurtured in the future. This restriction has been imposed because of the high profile of nursing education in Scandinavian countries.9 The importance and influence of trade unions in healthcare educational institutions are extraordinary in Scandinavian countries, which is why their opinions are also of great interest.5,16 Not only do they have a strong professional presence in the clinic as well as educational institutions, they also have strong political influence.16 To date, such a review has not been undertaken, as demonstrated by a search of the JBI Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Prospero and Google Scholar.

The purpose of this review is to systematically review the strategies at both a political and a trade union level in the three Scandinavian countries (Denmark, Sweden and Norway) regarding nursing talent needed by the healthcare system in the future. From an international perspective, this knowledge is relevant due to increasing globalization and skills transfer to countries where talent development is still an emerging concept and practice. Furthermore, in countries where talent development is more established, this knowledge will be highly relevant due to rapidly changing healthcare demands and the global shortage of nurses.

Inclusion criteria

Types of participants

The current review will consider views, opinions and recommendations regarding nursing talent needed in future Scandinavian healthcare systems put forward by policy makers and trade unions in Denmark, Norway and Sweden.

Phenomena of interest

The phenomenon of interest will be views, opinions and recommendations about the kind of nursing talent that will be needed by the healthcare system in Scandinavia in the future.

Context

The context will be Denmark, Sweden and Norway.

Types of publications and papers

The current review will consider government reports, expert opinion papers, discussion papers, reports, trade union papers and other forms of text. Numerical data such as those presented in technical reports, statistical reports and epidemiological reports will be excluded.

Search strategy

The search strategy will aim to find both published and unpublished studies, papers and publications. A three-step search strategy will be utilized in this review. An initial limited search of Medline (via PubMed) will be undertaken followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all the included databases. Third, the reference list of all identified reports and articles will be searched for additional publications and papers. As this review does not take a historical perspective but take a perspective into future request of talent publications and papers published from 2015 to the present will be considered for inclusion in this review. Publications written in English, Danish, Norwegian and Swedish will be eligible for inclusion in this review.

The databases and sources to be searched include:

CINAHL Complete

MEDLINE (via PubMed)

Svemed+

Svepub

Iduun

Norart

The search for unpublished studies will include

Google Scholar

ProQuest

Relevant webpages to be searched will include:

* The Danish parliament (folketinget), the Swedish parliament (riksdagen), the Norwegian parliament (stortinget), the Ministry of Health (Helse- og omsorgsdepartementet, socialdepartementet).

* Trade unions and trade journals such as Dansk Sygeplejerad, Norsk sykepleierforbund and Vardforbundet.

* National health boards such as Sundhedsstyrelsen in Denmark, Scoialstyrelsen in Sweden and Helsedepartmentet in Norway.

Initial keywords to be used will be:

Nurs* AND Talent OR talent development OR giftedness OR skills OR competences OR expert AND Future OR forthcoming AND Requirement OR necessity OR demand AND Healthcare system OR Health Service

Danish:

Sygeplejerske AND talent OR talent udvikling OR ekspert OR kompetent OR faerdigheder AND fremtid AND nodvendighed OR behov OR krav OR eftersporgsel AND sundhedssystemet OR sundhedsvaesnet

Swedish:

Sjukskoterska AND anlag OR talang OR Talang full OR formagor OR fardighet OR skicklighet OR expert AND fremtida OR kommande OR foretaende AND krav AND nodvansighet AND Tilkortkommande OR ofulkomlishet AND halsovardssystem OR halsovard

Norwegian:

Sykepleie AND talent OR begavelse OR talent forlop OR talent utvikling OR evne OR dyktighet OR ferdighet OR ekspert AND framtid OR kommende AND eftersporsel OR krav OR behov AND helsetjenste

Assessment of methodological quality

Textual papers selected for retrieval will be assessed by two independent reviewers for authenticity of opinion and source prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Narrative Opinion and Text Assessment and Review Instrument (JBI-NOTARI) (Appendix I). Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer.

Data extraction

Textual data will be extracted from papers included in the review by one reviewer using the standardized data extraction tool from JBI-NOTARI (Appendix II). Where necessary, the authors will translate only the relevant information and findings to be extracted and reported in the review from non-English papers. The data extracted will include specific details about the phenomena of interest, populations, study methods and conclusions of significance to the review question and specific objectives.

Data synthesis

Textual papers will, where possible, be pooled using JBI-NOTARI. This will involve the aggregation or synthesis of conclusions to generate a set of statements that represent that aggregation. This will be done by assembling and categorizing these conclusions on the basis of similarity in meaning. These categories will then be subjected to a meta-synthesis to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. Where textual pooling is not possible, the conclusion will be presented in narrative form.

Appendix I: NOTARI appraisal instrument

Appendix II: Data extraction instruments

NOTARI data extraction instrument

References