A framework for developing competence

Abstract

A competent healthcare workforce is essential to ensuring quality care. There are strong professional and societal expectations that nurses will be competent. Despite the importance of the topic, the most effective means through which competence develops and is assessed, remains elusive. The aim of this study was to evaluate a framework intended to promote competence in nurses new to paediatric practice.

Applying the principles of program theory evaluation, a two phase, mixed method design was employed. In Phase One, a qualitative exploratory method was applied. Documents related to the Nursing Competency Framework were audited. Twelve focus groups were conducted to gain understanding of the theory thought to underpin the development of nursing competence. Phase Two enabled a subsequent evaluation to be undertaken that was informed by Phase One. Phase Two was conducted as an explanatory sequential mixed method design. In the first strand of Phase Two, a quantitative method was applied to measure the extent to which competence develops over the first six months of a graduate nurse program (GNP). A tool to measure nurse competence, the Nurse Competence Scale (NCS), was administered to 47 graduate nurses at three time points during their GNP. The second strand of Phase Two employed a qualitative design. Twenty one graduate nurses were interviewed to explain the variations in competence development in light of their results from the NCS.

The Phase One findings generated a far more complicated program theory than had arisen from the preliminary audit of documents. Focus group participants articulated a range of processes that support the development of competence, created a comprehensive picture of contextual factors to be taken into consideration and drew attention to the many standards that inform competency development.

Results from the NCS indicated nurses made statistically significant gains in competence in the first six months of paediatric nursing practice. The findings from the interviews, considered in combination with the theory that had emerged from Phase One and the NCS results, enabled the conceptualisation of the Framework for Developing Competence. Key elements within the Framework for Developing Competence include; the individual within the team, identification and interpretation of standards, asking questions, guidance, and engaging in endeavours, all taking place in a particular context of practice. Competence is recognised as a combination of knowledge, skills, abilities and attributes. Excellence is identified as the hoped for outcome from which nurses return back through various processes to continuously improve.

Much time, energy and resources are directed at supporting the development and assessment of competence, with little evidence as to the most effective means. This study led to conceptualisation of a theory thought to underpin development of competence. The findings of this study will contribute to local, national and international knowledge related to competence both in nursing and other health professions.