Jules, You are right that I focused on how to assess the competencies, as that was part of my posed question I’ve been pursuing. I assumed that the lecture halls and labs for base knowledge and actual supervised client contact would not change in teaching, based on my proposed competencies. For the methods, I was assuming assessment, planning, intervention and evaluation were all to be modeled and taught, then measured against competencies for achievement. You also asked how I will assess professionalism and accountability. Professionalism is measured by following the policies, procedures and regulations set out by the health institution, the university and the CNO; it is also dress and hygiene, considerate language, behaviours showing respect for clients and other professionals and adhering to the Canadian Nurses’ Association, Code of Ethics document.
Ahmed, I could not find your commentary on my blog– sorry!
Anna, You asked how nurturing can be taught, where and how is it assessed. Although I consider nurturing to be more pronounced in some people, it is the role of the scholastic nurse educator to not necessarily engender this in students but to help make it overt behaviour within socially acceptable manners. I agree with you that professionalism does include ethics. Thanks for the CBC link!
Beth, Nurse leaders in Ontario at the time developed the CNO competencies, but I'm not sure when they initially came into existence It is interesting to consider the political climate at the time, as it actually was when nurses were lobbying for more rights for self regulation and autonomy in delivering health care, separate from physicians. You asked how I propose to assess nurturative behaviours and those are typically measured by attentive listening, open body language, hand holding, brow soothing, hugs, encouraging words, teaching behaviours and hand over hand guidance.
Thanks for all the feedback, Prof Potter. I want to address a few points you brought up. Bevis' theory includes the ideas of nurturative interventions (=nurturing), protective, which you equate with ethics and the third is generative interventions, where nursing attempts to stimulate growth and improvement. In the affective realm, protective nursing behaviours would certainly include ethics, such as the rights to privacy, confidentiality and self determination in healthcare decision making.
Regarding "competencies that reflect public service and professional self regulation," these would include lobbying, registration and licensing, ongoing education through reflective practice and discipline of errant members. "Ethical practice" is stipulated in a document called the Canadian Nurses’ Association (CAN), Code of Ethics which defines ethical nursing practice.
I believe accountability is "necessary" in order to preserve client dignity, promote and improve health and ensure safety of clients. I agree that not all areas of proposed competencies overlap all three learning domains and you came up with the ideal argument (basic anatomy) for that!
You also suggested that I should be careful about the implications of tying professional practice to "evidence-informed ideas". Professional nursing practice has been closely tied with evidence! In order to “do” nursing in other words, practice it, the choices for action should be evidence based, thus professional nursing practice should be grounded in evidence wherever possible. This shift in nursing circles from the term “evidence-based” ideas to “evidence informed” opens up room for creativity and critical thinking and unique solutions for individualized problems.
Hi Brenda,
ReplyDeleteNice summary of feedback! It sort of highlights where everyone has been pointing for you. I rather like your comment about evidence informed practice and nursing. In social work, as I suspect with many professions, we too use this language. Evidence-based practice was the buzz word for a number of years and then it softened to include “evidence” that might be viewed as less rigorous but nevertheless, comes with a perception of valuable and credible or perhaps at least possible. In the face of uncertainty, what do we know or what are the best possible chances that we are engaged in the most informed practices we know. In line with your ideas of accountability. And, it fits with our discussions about epistemology – what we believe. On the “belief” scale from faith to certainty, where might evidence informed practice fall, assumptions, justified beliefs, knowledge? And how do we know?
Beth
A good response to feedback, Brenda. Not really a post per se (it would have been more appropriate as a comment at the end of last week's post). Still, it's good to see you taking some time to make sense of and respond to what people are saying!
ReplyDeleteAgain, I wonder where you are in all of this. The answers you propose tend to accept what someone else says (i.e. the CNA) as the final word. Is professionalism what the CNA says it is? How would you define professionalism? What would happen if you evaluated these claims that you're relying on?
Sorry if I created misunderstandings with the phrasing of my comment last week! I don't necessary believe that protective = ethics; I meant that it seemed to be an implication of what you said about Bevis' theory, which I found interesting.
It still isn't clear to me why accountability would be necessary to preserve client dignity, promote and improve health and ensure safety of clients. If it were necessary, we could have client dignity, etc. *without* accountability. Yet it wouldn't be difficult to think of situations in which there was no accountability, yet clients were still treated with dignity, health was still improved and promoted, and clients were safe. I'm wondering whether you're thinking of accountability in a specific way that I'm not familiar with, or if you have a different concept in mind.
The distinction between "evidence-based" and "evidence-informed" seems useful, and as long as you use the qualifier "whenever possible", I think you're good to go! :)
I agree that accountability is part of professionalism. If there is an error notifying the patient is part of the transparency expected of the professionals involved. One of my physician friends was discussing how frustrated she was about the way the nurse alerted the patient of an error based on wrong information she received by an imaging technician; who, in this case had mistaken air for a perforation. When the image was sent back to the radiology department for a report it was realized that there was no perforation. Calling out the 'red flag' and discussing it in front of the patient I believe was unprofessional. On the other hand, if the nurse had discussed with the physician in private before alerting the patient would have been a more professional approach. At this point it is up the professionalism and ethical standard of the physician to call it as is (in this case it was not an error) once confirmed. If it was an error the professionalism of the physician demands that they make a record of it and discuss it with the patient. Having said that if the physician was not professional enough to do so, then the nurse would have to take further action in interest of the well fare of the patients’ health and be the health advocate.
ReplyDeleteI had a similar reaction to Michael in that as I read your post it seemed you set out to answer all our questions by providing evidence to the fact. For example, you explain how professionalism is 'measured'. But I wanted to know how you think it should be 'assessed' (I think this is a better word than measured). You also identified concepts (such as 'dress & hygiene, showing respect') and it would have been beneficial to know more about these concepts b/c I'm left to assume. They may seem intuitive, but how do we know we have the same conceptualization if it isn't expressed. I may be nickpicky - so feel free to thump me next week if I'm being pedantic.
ReplyDeleteI bring all this up b/c this was the challenge we had as a department when we created our degree rubrics. One person who worked in clinical setting wanted 'professionalism' as part of the outcomes of the degree. I remembered asking my colleague what she meant by professionalism and how would she knew when she saw it. From there we discussed how we might take her examples and find ways to define the examples so they generalized across situations. So we defined it for ourselves and I was interested in how you defined it or whether you content with the definitions provided by CAN/CNO.
Thanks for all the feedback everyone. In answering the issues each person brought up, I think I expressed my concern and maybe some frustration in class at the limitation of the blogs' electronic structure and maximum words, plus some uncertainty of the appropriate content of my blogs. I hope this week's blog will get me back on track. I apologize for the lack of clarity in my commentary.
ReplyDeleteThe focus of my peers and Prof. seem to centre around (to use Prof Potter's statement)"why accountability would be necessary to preserve client dignity, promote and improve health and ensure safety of clients. If it were necessary, we could have client dignity, etc. *without* accountability".
My original idea was the "proof" for demonstrating that a student understood and applied dignity, promotion of health and ensured safety. Accountability was demonstration of behaviours that reflect these important aspects of nursing. The accountability itself is being able to show others that affective learning has occurred, along with the performative and cognitive aspects of education.
The same goes for professionalism. They overlap in the idea that behaviours need to be consistently evident that the student upholds common ethical standards, dress, behaviours and skills that prevent client harm and prevent denegrate the profession of nursing. Examples would be a sleezy outfit, sexual impropriety, expecting tips ("T=to I=insure P=prompt S=service"), cultural insults, theft, witholding care... and the list goes on.
Professionalism and accountability are defined through the use of CNO competencies and CNA Ethics. Although they might not fully measure those concepts, there have been a struggles/discourse on what is the best way to ensure that nursing protects the vulnerable and promotes nursing.
I have been asked to explore this and every way I look at it, it seems to boil down to the core of human nature being selfish. When I'm tired, hungry, hurt, upset I am focused more on me and, like it or not, in turn I tend to care less for my clients' needs even if it is not intentional or obvious. Only when one's values and morals include selflessness can we choose to not have standards and competencies by which to ensure that selfishness does not drive our behavious.