Competency in Healthcare

A Practical Guide to Competency Frameworks

Les Storey, John Howard, Alan Gillies

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315358468
• Edition: 1
• Topic: Medicina
• Subtopic: Sanità, amministrazione e assistenza pubblica

This book offers a practical approach to guide nurses in the art and science of renal care. It is holistic as well as technical therapeutic and compassionate in its approach. Acute and chronic renal failure renal osteodystrophy and other selected diseases are comprehensively discussed. The nurse's role with regard to specific treatments such as peritoneal dialysis haemodialysis plasma exchange and haemoperfusion as well as organ transplantation procedures are discussed in detail and a section relating specifically to paediatric care is included. The final section of the book is devoted to the use of complementary therapies and alternative medicine in renal disease. 'The book lays the foundation on which nurses can build their evidence-based practice and knowledge skills and enhance patient care. The aim of this book is to provide a practical holistic guide for nurses to the skills and knowledge required by them to care for their patients. It covers the renal patients experiences both physically and psychologically incorporating the dialysis therapies of acute and chronic failure on to renal transplantation. Nursing renal patients within an acute hospital setting a chronic dialysis unit or a satellite unit places many challenges on the nurse caring for them today. I therefore hope that this book will provide the knowledge needed by those working in the field of renal nursing and that it will be used as a resource in renal units throughout the UK' Avril Redmond Chair of RCN Nephrology Nurses Forum in the Foreword

1

Competence and competency

Introduction

Throughout healthcare the competences required to provide an effective service to our patients are continually being utilised. When a patient attends a hospital for an out-patient appointment they will encounter many different staff groups, all of whom need a range of competences to do their job. These may include porters, receptionists, care assistants, nurses, doctors, radiographers, physiotherapists, occupational therapists, phlebotomists and pharmacists, to name but a few.

Many of the competences will be common across the disciplines, but the levels of proficiency required to carry out the task may vary. For example, the simple task of communicating with a patient will vary significantly; the porter may be required to give directions to the clinic whilst the nurse, doctor or other healthcare professional may be required to provide complex information to patients who may be distressed and anxious.

Another example would be an individual who is involved in a road traffic accident and as a consequence suffers a broken limb. At all stages of the process of dealing with this patient, different levels of proficiency are needed because of the different contexts within which care is delivered. These include:

• at the scene of the accident
• in the accident and emergency department
• in the radiography department
• in the operating theatre
• on the ward
• in physiotherapy
• at home.

One of the competences that will be common across all of these areas is ‘Assess patient’s healthcare needs’. At each stage in the care continuum the healthcare professionals involved will need to have the appropriate level of proficiency to deal effectively with the patient and assess their needs:

• the ambulance paramedic
• the receptionist
• the A&E triage nurse
• the senior house officer
• the radiographer
• the operating department assistant
• the theatre nurse
• the surgical registrar
• the anaesthetist
• the recovery-room nurse
• the ward clerk
• the ward nurse
• the consultant
• the healthcare assistant
• the physiotherapist
• the community nurse
• the general practitioner.

In assessing the health needs of the patient at each stage of his care trajectory, different skills, knowledge, understanding and decision–making are required because of the different contexts within which the assessments are taking place. The paramedic will be making assessments of need in conditions that could be dangerous to them and to the patient; they are the first on the scene, delivering emergency aid, prioritising actions and determining the immediate future care needs. In the accident and emergency department the triage nurse will assess needs at another stage; she will identify options available within the department and will plan the throughcare of the patient in A&E.

Whilst in A&E the senior house officer (SHO) will use skills and experience to determine the best means to meet the patient’s needs. They will have to decide if they can deal with the patient themselves or if they need to involve more senior medical staff.

Having decided on a course of action, the patient moves on through the radiography department then on to the operating theatre, where choices of treatment are again made; the orthopaedic registrar makes a choice between reduction of the fracture and the use of plaster casts or surgical intervention and pinning and plating the fracture.

And so the process of’ Assess patient’s healthcare needs’ goes on. It can be seen from these examples that a range of competences are needed to deal with each patient interaction, and that for each of the competences a range of proficiency levels are required by each of the disciplines involved in care delivery.

This book has been compiled as an aid for healthcare practitioners and managers in order to raise awareness of the issue of competence and to provide guidance on how to implement competence frameworks and utilise them as part of a strategic approach to developing a workforce that meets society’s healthcare needs.

The book provides a background to competency-based approaches to healthcare, sets the current policy and strategies in context, and gives illustrations of a number of case studies where competency frameworks are being introduced.

The concept of competence

The need for defined competences for healthcare professionals has been clearly articulated by many organisations and authors (Benner 1984; Storey et al. 1995a, b; UKCC 1999a, b), including the recently published inquiries at Bristol Royal Infirmary (NHS Executive 2001) and Oxford Cardiac Services (NHS Executive 2000). The emerging competence frame-works and portfolio systems are providing a foundation to support lifelong learning and continuing professional development.

Competency frameworks can also be utilised by employers to develop competency-based job descriptions. Competency-based job descriptions enable employers - and employees - to have a clear understanding of expectations in relation to role performance; they can be used to undertake training needs analysis, contribute to individual performance review, and provide a basis for developing continuing education packages that meet the needs of the service and individual employees.

Despite the significant interest and investment in competence and competency-based education, there are still some barriers to the universal acceptance of outcomes-based approaches to professional nursing education. Competency-based approaches are still seen by some to be less attractive than traditional qualifications and to a certain extent professional and academic snobbery still exists. Another criticism that has been levelled at competency-based approaches is that the assessment processes are sometimes paper-driven and bureaucratic.

However, from the level of activity being undertaken by statutory bodies, including the General Medical Council and UKCC, professional organisations such as the Royal College of General Practitioners and the Royal College of Nursing, education providers and employing organisations, the momentum to develop and implement competency-based approaches to professional development programmes continues to grow. Competency-based approaches provide a mechanism for all key stake-holders in healthcare provision to ensure the quality of the care provided and to contribute to public protection.

Competence can be defined as the ability of the practitioner to practice safely and effectively to a professional standard. And as such the practitioner should be able to determine their level of competence in carrying out particular functions and take measures to develop and maintain competence. To be competent it is not enough to be able to fulfil a particular function; the competent practitioner must have the ability to problem solve, think critically and utilise effective evidence on which to base their practice and work within a multidisciplinary team.

Competence, higher education and employment

It is generally accepted that until the latter part of the twentieth century the main aim of higher education was to create knowledgeable individuals who by their knowledge had more likelihood of becoming competent. It could be argued whether they actually became competent was outwith the interests of higher education. Educational programmes within higher education are designed to produce graduates who have the capability to become competent practitioners. They instil knowledge, skills and understanding in the students, but will fail to meet the needs of employment if another dimension is missing. That dimension is application. If students cannot apply their knowledge, skills and understanding in the workplace, then education is failing to meet market need (Storey 1998). As we moved towards the twenty-first century the needs of employment became a key issue. This was acknowledged within the United Kingdom when a commission into higher education was established in 1996. Gillian Shepherd, then Secretary of State for Education and Employment, said:

Today’s graduates face a different world from their predecessors. They must be prepared for changes in the nature of work and the greater demands it makes. Increasingly, they will need to switch career more than once in their lifetime. We must ensure that they are equipped with the skills and flexibility needed by the labour market of the twenty-first century - through both initial education and updating and up-skilling throughout their lives. Higher education must be in the best shape possible to meet these needs … As the pace of change quickens, there will be a greater premium on the capacity to innovate … Higher education can help too to drive local and regional regeneration through services to employers.

(Shepherd 1996)

Healthcare within the United Kingdom has responded to this challenge with a number of policy documents from the Government and statutory bodies focusing on competency approaches and the need to produce practitioners ‘who are fit for practice, fit for purpose and fit for award’ (UKCC 1999a). These initiatives have resulted in the development of a new curriculum for pre-registration nursing that is designed:

… to prepare the student to provide the nursing care that patients require, safely and competently, and to assume the responsibilities and accountabilities necessary for public protection.

(UKCC 1999a)

The issue of competence in healthcare appears to be a key agenda item in a number of countries, including the Republic of Ireland, the United Kingdom and Australia. The International Council of Nurses (ICN) has acknowledged that because of the developing global market ‘there is conside...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Why you should read this book
• About the authors
• Acknowledgements
• 1. Competence and competency
• 2. Clinical governance and competent practitioners
• 3. The model
• 4. Case study 1: Developing competency-based frameworks for nurses within Blackburn, Hyndburn … Ribble Valley NHS Trust
• 5. Case study 2: Staff development amongst staff assessing and treating personality disorder
• 6. Case study 3: Competency profiling in health informatics
• 7. Linking competency to organisational development
• 8. Case study 4: Electronic health records in primary care
• 9. Linking competency to a-learning
• References
• Further reading
• Index