Cancer and Palliative Care Competencies: Empowering or constraining

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Cancer and Palliative Care Competencies
Empowering or constraining

• Mr. R Becker
• Macmillan Senior Lecturer in Palliative Care
• Staffordshire University and Severn Hospice
  Shropshire England

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Eighty percent of success in life is related to
attitude rather than competency Anon
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Competencies can be seen as

• A universal panacea which will revolutionise
  skills based training and education
• The Emperors new clothes

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What is competency?
The skills, knowledge, experience, attributes
and behaviours required by an individual in order
to perform the job effectively (RCN 2002)
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The core skills of palliative care nursing
1. Communication skills 2. Psychosocial
skills 3. Team skills 4. Physical care
skills 5. Life closure skills 6. Intrapersonal
skills
Becker R (2000) Competency Assessment in
Palliative Nursing . European Journal of
Palliative Care. Vol 7. No 3. Pages 88 91.
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A comparative view of the skills development of
district nurses using a competency assessment tool
COMMUNICATION SKILLS
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Designing a competency statement

• The core components
• Knowledge
• Skill
• Behaviour/attitude

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Examples include

• K - Discuss the concept of total pain and its
  relevance to patient centred care in a palliative
  context
• S - Conduct a pain assessment interview using a
  range of available frameworks and tools
• B/A - Demonstrate and articulate an active
  commitment to the holistic assessment of pain

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Complex statements that involve reflection and
professional maturity

• Demonstrate respect for the inherent worth of
  others, coupled with a predisposition to look for
  the good things in people, and an intrinsic
  belief in this
• Recognise and attempt to understand your own
  reactions and feelings when caring for the dying
  and bereaved, reflecting on how this affects the
  care given in sensitive situations

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• I now see myself more as my peers see me, some of
  this I like and some of this I was surprised
  about.
• I know I am judgemental and I have been working
  with someone who isnt, to try and improve and
  learn
• By focusing on how competent others see you it
  gives you another perspective on your own
  abilities. Honesty is everything.
• I was told that I was not as good at listening as
  I thought. I was afraid of silence and I needed
  to practice this more. I never realised.

Becker R (2000) Competency Assessment in
Palliative Nursing . European Journal of
Palliative Care. Vol 7. No 3. Pages 88 91.
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INTRAPERSONAL COMPETENCE
Becker R (2007) Ch 2, The use of Competencies in
Cancer and Palliative Education, in Foyle L
Hostad J (2007) Innovations in Cancer and
Palliative Care Education, Radcliffe Press
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Integrating Competencies?

• USA Robert Wood Johnson Foundation (Ferrell et
  al 1999)
• Medical Education . (Pall Med Curric 1992)
• Nursing ? Ad hoc (Lloyd Williams Field 2002)
• Allied Health Professionals ? Ad hoc (Becker
  2007)

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The Notion of Competency Assessment
There is a climate of uncertainty amongst
nurses, who are confused and overwhelmed by the
proliferation of methodologies presented to them,
which are often written in educational language
that they are unfamiliar with.
Becker R (2000) Competency Assessment in
Palliative Nursing. European Journal of
Palliative Care. 7. (3) p88-91.
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The way forward?
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Universities, Educators and professional bodies

• Identify appropriate modes for education delivery
• Education and training commissioning with local
  providers
• Facilitate competency acquisition in the
  workplace work based learning
• Provide uniform, clinically relevant and
  standardised content for cancer and palliative
  care education programmes.

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Individual practitioners

• Plan and develop their career pathway.
• Identify their own training and education/skill
  requirements.
• Access appropriate education initiatives
• Self-assess performance in relation to Individual
  Performance Review (IPR) and the development of a
  Personal Development Plans (PDP).

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Managers

• Assessing ongoing competency as part of the IPR
  process.
• Informing future roles and responsibilities, job
  description and person specification development
  (DOH 2005)
• Measuring competency within a team to inform
  skill mix review and staffing establishment.
• Identify workforce training needs.
• Monitor progress for achieving national targets
  and standards.

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...When we speak of challenges we must not
forget that of teaching and enthusing our
professional colleagues and students. I suspect
we have got it wrong. We are filling the syllabus
with doses and data when we should be trying to
change attitudes. Wherever I travel in the world
I find palliative care workers who feel they must
justify their existence, particularly if they
have specialist status, and they do so by
parading facts and figures rather than sharing
some of the profound insights which so
characterise palliative care.. Derek Doyle 1999
Farewell Address. Geneva.
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Thank you for listening
Mr. R Becker Macmillan Senior Lecturer in
Palliative Care Staffordshire University and
Severn Hospice, Shropshire, England
E mail bobb_at_severnhospice.org.uk