My “gift of a challenge” was: “Say my discipline didn’t predetermine the competencies graduates are supposed to have, what competencies would I choose, why those particular ones, and how would I help students learn them?”
For a starting point, I refer to the College of Nurses of Ontario’s mission and vision statements: “Our mission is to protect the public’s right to quality nursing services by providing leadership to the nursing profession in self-regulation;” Our vision is “excellence in nursing practice everywhere in Ontario.” The National Competencies document describes that quality care as being “safe competent and ethical”. There are 123 competencies that must be met for ongoing licensure.
I would choose competencies that meet the core reason for the existence of nurses, premised on Em Bevis’ theory. A nurse’s role is to provide care in preventative, nurturative and protective ways. Any behaviours that reflect safety, nurturing and ethics would be a start for measuring competency. By also using the foundational systems theory of care, those 3 levels of care can be applied to individual clients, families, communities, nations and global health care.
I would initially choose competencies that are more directed to the traditional role of bedside care, promoting preventive behaviours in clients and protecting vulnerable clients, all from a holistic viewpoint of bio-psycho-social-spiritual health.
Safety competencies are the 1st level competencies required in order to prevent errors, accidents and psychological harm. Student must demonstrate the ability to apply safety considerations and rules, plus establish trust in therapeutic client relationships. This is similar to the Hippocratic oath physicians are encouraged to adopt, essentially “to 1st do no harm.”
Professionalism and accountability must be established before anyone can practice the art and science of nursing with clients, so that is the next cluster of competencies to apply.
Core facts and evidence-informed ideas are necessary to make quality health care decisions for clients, to increase chances of survival. Based on this, competencies that demand demonstration of basic anatomy, physiology, patho-physiology, pharmacology, psychology, sociology and spirituality would be a next step for competency demonstration.
Next, competent application of knowledge needs to be measured, usually through the ability to identify prioritized nursing diagnoses, the development of collaborative plans of care and implementation of that plan, followed by ongoing evaluation of client care: the nursing process.
Ethical practice cannot be overlooked and neither can competencies that reflect service to the public and professional self regulation.
Whew! Now, how to help students learn these competencies on performative, cognitive and affective levels.
Once learning outcomes incorporating these competencies have been set, I would establish assessment assignments with corresponding marking rubrics. Those assessment assignments would have to incorporate basic, progressing to advance level synthesis of information, theories and ideas via SOLO taxonomy levels. Teaching/learning theories and evidence point to problem solving and critical thinking as the desirable outcomes to any learning. To that end, case studies asking for students to synthesize information in order to suggest provision of holistic healthcare in preventative, nurturative and protective ways would be a start once basic evidence-informed data is learned. Performance of standardized skills in a lab is also desirable before students attempt to care for clients. I would model and discuss desirable professional behaviours. Written examinations testing recall of expected information would help to establish some evidence of basic knowledge. Supervised care of less vulnerable clients, progressing to more complicated clients as students progress through their nursing education is practical. The use of a variety of learning methods is desirable in order to meet learning styles and to give different perspectives on expectations of competency achievement.
Brenda,
ReplyDeleteWow - you were given a great challenge (not that I wasn't, I just really liked yours). As I read, I had a couple of thoughts. First, it seems you presented the competencies as a linear or hierarchical process. Was this your intent? Second, it seems that you focus more on how you'll assess these competencies rather than how students will learn them. I know you mention modeling, supervision and case studies. I just thought you seemed more focused on assessment. Third, with assessment, you've identified some competencies that seem easier to assess (i.e., content knowledge, application) than others (i.e., professionalism, accountability). How will assess the latter? I've had a similar conversation on this matter when I worked in the States, so I'm interested to know how you would approach this issue.
Hi Brenda,
ReplyDeleteFirst, I apologize for the late response. I didn’t realize you posted so early. I checked at the beginning of the day but didn’t see it. Instead, I only saw your week 4. Sorry.
OK, I agree with Jules. Wow! A hugh response. I didn’t know where to begin. It just seemed so big. How does one prioritize 123 competencies?
I liked that you started with core competencies, then I wondered when these were developed and by whom? What was the political context at that time? You noted safety, professionalism, evidence informed ideas, application of knowledge and ethical practice as priorities for competencies. You then noted you would have students synthesize information related to preventative, nurturative and protective aspects of nursing. I see the preventative and protective aspects but not the nurturative. How do you envision this being assessed?
Beth
ReplyDeleteHi Brenda,
Our challenges are quite similar. I see the arrangement of competencies but do wonder if we can prioritize them at all. I feel it’s more like the spokes of the same wheel or nursing. I was wondering if the core word for nursing is from nurturing. I agree with Brenda is that nurturing (I feel) is almost a personality type. So I wonder if it can be taught and if so where can it be taught and how is it assessed. As for professionalism; is not ethics part of it? An interesting listen, especially after last class where our basis to teaching...knowledge got shaken at the roots! Ideas on CBC radio: Science of Moralities. http://www.cbc.ca/player/AudioMobile/Ideas/ID/2289397896/ kind of talks about it briefly.
There's a sense of increasing clarity in here, Brenda, regarding what YOU believe and value versus what the sources you've previously cited believe and value - -and that was our intent in issuing the challenge. I'm excited to see how you can use the ideas you're developing here to answer the questions you were asking in previous posts. Fewer ideas from other people, more ideas from Brenda. That's the goal!
ReplyDeleteI remember Bevis' theory from CDCA. So, preventative=safety, nurturative=nurturing, and protective=ethics, correct? That seems fine as a starting point.
You've indicated 7 competencies from what I can see (8 if you intend accountability to be something distinct from professionalism, fewer if you see most of these as aspects of professionalism), which is a big improvement over 123! One step in defining competencies (which you must do, of course, if you're going to assess them) is distinguishing them from other competencies. At this bound the boundaries are quite fuzzy. It isn't clear, for instance, whether professionalism is supposed to be a competency in itself, or whether you're using it as a name for a category of competencies. And it isn't clear exactly what professionalism includes -- it looks to me like you want it to include knowledge of core facts and evidence informed ideas, but is it also meant to include the three competencies in the next paragraph?
At one point you suggest competencies that you don't identify -- "competencies that reflect service to the public and professional self regulation". What are these? Hopefully there aren't 100 of them. :) "ethical practice", like professionalism, is used by various people to mean practically anything. So you definitely need to define it. What kind of definition will you stipulate?
At one point you say that professionalism and accountability are "necessary", which caught my eye. That's a big claim! It means something is impossible without them. I would suggest arguing for this claim, showing us why these things are necessary and for what.
It isn't clear to me why each of these competencies would need to be learned in the cognitive, performative and affective domains. Some of these seem irrelevant to certain competencies. What would it mean, for instance, to demonstrate knowledge of basic anatomy in the affective domain?
Finally (minor point!), be careful about the implications of tying professional practice to "evidence-informed ideas". Apart from the heavy lifting involved in defining "evidence", you may also inadvertently rule out perfectly sensible ideas that are neither supported nor contradicted by the evidence available.
Glad to see this, Brenda. I want more of this! More of YOUR ideas and reasoning. :)