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Concept analysis of competency

CONCEPT ANALYSIS OF COMPETENCY

Conceptanalysis is described as the process that clarifies the defining andirrelevant attributes of a concept by breaking a concept into simplerelements and considering the similarities and differences (Bergdahl &ampBerterö, 2016). The creation of clarity of a given concept isimportant in nursing research and practice. Concept analysis isnecessary for theory development and research. Theory development canbe accomplished by inductive, deductive process or a combination ofthe two. Lange, J. W. (2011) argues that the content of a theorycomes from concepts, other theories, practice, research or acombination of two or more of these sources. The analysis is solelyan inductive process of theory development. It is used in nursing inenhancing the application of various concepts in practice.

Consumersin the health industry expect quality care from health institutionsand professionals. Nursing practice influences the health carequality significantly. The concept of competency is widely used innursing and other disciplines for ensuring the quality of servicesand products delivered. The competency of nurses influences theirunderstanding of their duties and how they can employ variousstrategies. Clients have the right to expect registered nurses todemonstrate professional competency throughout the healthcare servicedelivery process. Ensuring competency in nursing practice is acollective responsibility. Stakeholders in the nursing professionhave the responsibility to shape and guide any process for assuringnurse competence. This concept is essential in the provision of rightservices, in the right way, at the right time and by the rightperson. The concept of competency is derived from the Novice toExpert theory developed by Patricia Benner.

Thispaper analyzes competency using various aspects. Firstly, there isthe definition of the concept. The second part presents nursingresearch studies on competency. The next part involves thedescription of the defining attributes of the concept. Theantecedents and consequences of the competency concept are alsodiscussed. The paper explains the empirical referents employed inmeasuring the concept. Model and alternative cases are used to showthe application of competency in nursing practices. The paperconcludes by providing a summary of the concept and its applicationto enhance nursing outcomes.

Definition of competency

There are variousdefinitions of the term competency. A uniform understanding isuseful. The Oxford Dictionary describes competency as the ability toperform a certain task efficiently. According to the dictionary,competency and competence have the same meaning. However, theoristsdisagree with the understanding generated by Oxford Dictionary. Theyrelate competence to the action of nurses in their duties. Competencyis related to the characters of nurses that enable them to performtheir responsibilities successfully. There is no consensus about thedifference between competency and competence. Such a phenomenon makesorganizations develop their own definition that further complicatesthe understanding of the concept.

The AmericanNursing Associated (ANA) refers competency as the expected level ofperformance that integrates knowledge, skills, abilities, andjudgment. Examples of nursing skills are communication,interpersonal, and decision-making skills. Knowledge involvesthinking, understanding of concepts and professional standards, andinsights obtained from practice experiences. Abilities refer to thecapacity of nurses to act accordingly. Judgment enables care giversto engage in critical thinking, ethical reasoning, solving problemsand making decisions. According to ANA, nurses who have competencycan use a combination of the above elements to achieve theirprofessional objectives.

Josephsen, J.(2014) defines competency as the know-how that nurses develop fromthe combination and engagement of knowledge, skills, attitudes, andresources and apply to a given situation. It provides a conceptualframework of the novice to expert and critical theories. In boththeories, instilling competency ensures the development of a wholenurse who has the ability to meet the needs of a contemporary nursingpractice. The inclusion of the concept in health profession givescaregivers evaluative and reflective skills that enable them to beware and analyze their abilities and thought the process inaddressing their duties. While studying the novice to expert theory,Gardner L. (2012) emphasized the importance of competency in ensuringpatient’s safety. Nurses learn throughout their profession fromelementary to advanced skills and basic tasks to more complex.

The concept isused in the development of nurse education curriculum.Competency-based curriculum defines good performance in nursingpractice and then facilitates it. The training strategy that is basedon competency analyzes the prevailing nursing environment byperforming a breakdown of their needs. This way, nurses will be ableto manage the dynamic needs of patients. Competency-oriented trainingalso ensures that knowledge, skills, attitudes and values ofcaregivers are clear, concise, specific and consistent withprofessional standards of practice. The approach is aimed atpreparing independent and competent nurses who are capable ofexecuting their tasks.

Literature review

Lee, Park &ampJeong (2012) carried out a study to examine the nursing corecompetencies needed for nursing graduates in order to improve thenursing curriculums. The investigators recruited ten nursing managerswho were responsible for clinical nursing education in the fields ofnursing practice. Data collection was done through group focusinterviews. The researchers identified six categories of nursing corecompetencies therapeutic, professional, administrative, humanisticrelational, and personal nursing capabilities. Graduates need theseattributes to efficiently deliver health care services. Theinvestigators recommended the revision of nurse education curriculumto ensure consistency with the competencies in classrooms andpractice. Nursing students or new nurses should be evaluated for thecompetencies to determine their readiness to deliver what is expectedof them.

Task performancestyles, communication, and their combination influence the nursingcompetency of nursing students and their ability to solve problems.Lee et al. (2011) carried out an investigation to examine thephenomenon. 56 fourth year nursing students participated in thestudy. The researchers classified the participants into two groupsaccording to the communication abilities, and four groups based onthe task performance approach and communication ability.Problem-solving skills and nursing competency were measured and usedto compare the groups. Communication had a significant relationshipwith competency and problem-solving ability of the nursing students.Lee et al. (2011) concluded that nursing colleges shoulddesign their training programs in a manner that improves thecommunication skills of graduates. Communication ability is anessential part of nursing competency.

Teachingeffectiveness and the clinical environment influences competency ofnurses. The study by Han &amp Park (2011) aimed at examining theimpacts of teaching efficiency and clinical learning environment oncompetency. They recruited 26 undergraduates who completedquestionnaires. The results of the study indicated the existence ofsignificant positive relationships between teaching and learningenvironment and nursing competency. Therefore, stakeholders ofhealthcare industry should invest in training of nurses and ensurethat the learning environment is conducive for the development ofnursing competency. The investigators also argued that registerednurses should also be provided with favorable working conditions toenhance competency development from novice to expert.

Quality and safehealth care is a patient-based approach to service delivery thatevery health caregiver should embrace. The ability of nurses todeliver quality and safe care to their clients is based on theirskills and knowledge. Piscotty, Grobbel, &amp Tzeng (2011) conducteda study to compare between an innovative teaching approach andtradition training in equipping nursing students with necessaryskills, know-how, and attitudes to execute their duties as expectedof them. The innovation resulted in the improvement of self-efficacyand knowledge of the students regarding quality and safetycompetencies in nursing practice. The study findings suggest theregular review of the training programs to meet the needs of thestudents, patients, and nursing practice.

After completingnursing training in college, nursing graduates are considered capableof addressing various issues in practice. Not all nursing studentshave all that it takes to deliver what is expected of them. There isa need for a validation strategy that health institutions shouldemploy to assess new nurses. Levine J. &amp Johnson J. (2014), in astudy, explored the essential components of organizational validationstrategy. The components are the development of clear definitions,selection of competencies, initial and progressive competencyassessment. They emphasized on the need to identify the competenciesthat a nursing student must have to be allowed to provide health careservices. The continuous competency assessment analyzes howregistered nurses have improved regarding nursing competency andidentify limiting factors and solutions.

Bernabeo &ampHolmboe (2013) argue that competency is a concept required of notonly nurses and providers but also the patients. In the study, theinvestigators explore the knowledge, skills, and attitudes thatclients, nurses, and providers need to successfully engage patientsin service delivery. Competencies of patients include co-producerroles, evaluation skills, and literacy. Quality and patient-centeredservices are achieved when clients act as co-produces of their healthoutcomes. They should be effective partners with nurses. Literacyenables the patients to understand the complex information that iscommon during service delivery. Patients can be useful in theassessment of nurses’ competency by providing data on theirperformance. Shared decision-making is an element of nurses’competency for that promotes patient engagement. The engagementrequires support from health care systems. It involves the provisionof an enabling environment right from training colleges to the actualpractice.

Defining attributes of competency

Thecharacteristics of competency enhance one’s understanding of theconcept. Three defining characteristics of competency areself-reflection, education, and judgment.

Education

There is a widerange of disciplines where nurses attain competency. These areasrequire adequate specialty education that imparts knowledge andskills nursing students and registered nurses. Education ensures thatnurses have the ability to tackle various issues in service delivery.Quality care cannot be achieved unless caregivers are adequatelyprepared. There is also the need for maintaining knowledge onceacquired. This is what is responsible for the advancement of nursesfrom novice to expert.

Self-assessment

Self-reflectionrefers to the recognition of one’s abilities, strengths, andweaknesses in performing various tasks. Nurses whose weaknessessurpassed their strengths in performing specified tasks lackcompetency. Nurses should feel obligated to accept certainassignments if only they are aware that they have the competency toproduce the desired outcome. If it is not the case, there ispotential harm to the patient.

Judgment

Decision-makingand problem-solving are essential elements of competency in nursing.Judgment is key in both elements. It enables nurses to provideoutcome-specific care. Nurses encounter challenging situations thatmust be addressed adequately to produce quality and safe health care.An appropriate judgment enables them to solve the problem inquestions. The first step involves the definition of the problem anddesired outcomes. Decision-making process relates the situation withthe desired results and then come up with an effective strategy forachieving the goal. This process requires adequate knowledge andskills relevant to the situation.

Antecedent and consequence of competency

The antecedent ofthis concept is knowledge and skills. A nurse must have requiredskills, knowledge, and attitudes to be considered to have competency.Knowledge and skills are required in decision-making,problem-solving, interpersonal skills, critical thinking and ethicalskills, and insights of the nursing practice. The antecedent isacquired through education and regular training.

The result ofcompetency in nursing is performance. The development of competencyby nurses gives them the ability to effectively execute their duties.They become able to deliver patient-centered health care service thatis responsive to the dynamic demands of clients. The excellentperformance of caregivers due to the concept creates trust in theiremployers, clients and the public.

Empirical referents

StructuredObservation and Assessment of Practice (SOAP) and UVICself-assessment tool are empirical referents of the concept. SOAP isa contextual and holistic tool for evaluating the competency ofregistered nurses as well as nursing students (Cant, McKenna &ampCooper, 2013). The tool is designed to enable nurses to reflected ontheir practice and learn from their daily experiences. The assessmentinvolves 6 hours assessment of knowledge, skills, behaviors,attitudes and values in a clinical context. The technique employsprobing and open-ended questions to provide insights aboutintentions, knowledge, rationales and values underlying significantexperiences of nurses. UVIC self-assessment provides the frameworkfor evaluating various skills and knowledge of caregivers. Nursesassess themselves using 1-5 scale.

Model case

Beverly Collegeis among the nursing training institutions in the US. In 2008, themanagement assessed the training programs the institution used inrelation to the market demand. There was the need for the revision ofthe curriculum to facilitate the inclusion of strategies that enhancethe nursing competencies. The revised curriculum facilitated theacquisition of the latest knowledge and skills required to addressthe dynamic demands of the clients. The use of advanced technologysuch as informatics was given much importance. The institution usedSOAP to assess the competency of the nursing students every year.After reviewing the curriculum and witnessing the abilities of theproducts of the college, most employers preferred to graduates fromBeverly. The graduates displayed exemplary performance in deliveringpatient-centered care.

Alternative cases

Borderline case

Mary spentseveral years as a county security officer and then left to attendnursing training. Just months after completing her college, she gotemployed as a nurse at a community hospital. During the initial weeksof practice, her preceptor, James, reported to the staff developmentofficer (SDO) that Mary displayed difficulties in prioritizing andforgets patient’s requests. She also had problems in theadministration doses of insulin. The manager and SDO summoned Mary tofigure out where the problem was and developed a solution. The SDOapproached James to inquire about her progress, but the response wasnegative. May’s problem seemed to be in her ability to carry itout.

Contrary case

Christian, anexperienced community health nurse, got a new job in the emergencyunit of a Hope Hospital (not real name). Christian proved to becompetent in performing his duties. One day on a night shift, hereceived the instructions from the daytime nurse regarding patients’medication. He acted according to them. However, during the daypatients at his disposal developed complications during the day.Analysis of the case indicated that the complications were caused bymedication errors due to miscommunication during the handover betweenChristian and the day time nurse. The handwriting of the daytimenurse was not clear. Such conditions were not conducive forChristian’s competency.

Conclusion

Competency is anessential attribute of nurses in their practice. It describes the setof skills that nurses require to efficiently perform their duties. Itshould not be confused by competence which is tied to the action ofnurses. Competency is tied on the skills, knowledge, and values ofcaregivers required to achieve specified goals. Adequate education isnecessary to equip nurses with abilities that facilitate theirduties. Therefore, competency development begins from health trainingcolleges. The Novice to Expert theory posits that there is thecontinued growth of nurses throughout their professional life.Continuous assessment is necessary to determine the competency andprogress caregivers in service delivery. The concept analysisprovides an enhanced understanding of competency and its applicationin nursing practice.

References

American Nursing Association, Competency Model, retrieved fromhttps://learn.ana-nursingknowledge.org/template/ana/publications_pdf/leadershipInstitute_competency_model_brochure.pdf Accessed 20 November 2016

Bergdahl, E., &amp Berterö, C. M. (2016). Concept analysis and thebuilding blocks of theory: misconceptions regarding theorydevelopment.&nbspJournal of advanced nursing.

Bernabeo, E., &amp Holmboe, E. S. (2013). Patients, providers, andsystems need to acquire a specific set of competencies to achievetruly patient-centered care.&nbspHealth Affairs,&nbsp32(2),250-258.

Cant, R., McKenna, L., &amp Cooper, S. (2013). Assessingpreregistration nursing students` clinical competence: A systematicreview of objective measures.&nbspInternational journal ofnursing practice,&nbsp19(2), 163-176.

Gardner, L. (2012). From Novice to Expert: Benner`s legacy for nurseeducation.&nbspNurse education today,&nbsp32(4),339-340.

Han, J. Y., &amp Park, H. S. (2011). Effects of teachingeffectiveness and clinical learning environment on clinical practicecompetency in nursing students.&nbspJournal of Korean Academy ofFundamentals of Nursing,&nbsp18(3), 365-372.

Josephsen, J. (2014). Critically Reflexive Theory: A Proposal forNursing Education.&nbspAdvances in Nursing,&nbsp2014.

Lange, J. W. (2011).&nbspThe nurse`s role in promoting optimalhealth of older adults: Thriving in the wisdom years.Philadelphia: F.A. Davis Company.

Lee, M. H., Kim, H. K., Jeong, S. H., &amp Moon, I. O. (2011).Effects of task performance style in nursing management practicum onproblem-solving and nursing competency according to communicationability of nursing students.&nbspJournal of Korean Academy ofNursing Administration,&nbsp17(1), 106-114.

Lee, S. K., Park, S. N., &amp Jeong, S. H. (2012). Nursing corecompetencies needed in the fields of nursing practice for graduatesin nursing.&nbspJournal of Korean Academy of NursingAdministration,&nbsp18(4), 460-473.

Levine, J., &amp Johnson, J. (2014). An organizational competencyvalidation strategy for registered nurses.&nbspJournal for nursesin professional development,&nbsp30(2), 58-65.

Piscotty, R., Grobbel, C., &amp Tzeng, H. M. (2011). Integratingquality and safety competencies into undergraduate nursing usingstudent-designed simulation.&nbspJournal of NursingEducation,&nbsp50(8), 429-436.