Competencies – An Ethical Challenge for Nursing Education and Training
- 1. Department of Education Sciences, University of Applied Sciences of Western Switzerland, Switzerland
CITATION
Haberey-Knuessi V, Dancot J (2016) Competencies – An Ethical Challenge for Nursing Education and Training. Ann Nurs Pract 3(6): 1067.
INTRODUCTION
Competencies have become key elements of many educational and training. At the very core of nursing practice, they are seen as being able to address the complexity of the practice by dividing it into distinct fragments that can rapidly be indexed with respect to professional and societal realities. As competencies have become more and more common in educational courses, they have brought about changes in both educational methods, which are increasingly focused on problem-solving, and teaching practices, particularly with respect to assessment. Using competencies helps to understand the profession and all its various components. But if education and training are based exclusively on the notion of competencies, a number of ethical issues must be addressed, concerning both knowledge and our expectations of the future healthcare professionals.
Competency Frameworks Ordained by Practice
At an educational level, work-based learning uses a constructivist approach to competency development, i.e. students play an active part in their learning. As a measuring device, competency frameworks provide an assessment tool that allows us to judge a student’s achievements with respect to expected outcomes, in the light of clearly defined criteria and indicators. Such frameworks, which originated in the world of business with its listed, expected competencies, are intended to bring teaching and learning processes closer to the real world [1]. But, although they have many undeniable advantages, competency frameworks nevertheless present a number of weaknesses, such as their rigidity and focus on the performance of specific actions. Competency based assessment is a delicate process, as it has to integrate the complexity of real life situations whilst continuing to refer to expected outcomes. And assessment is even more complex when the object of the assessment involves interpersonal skills, something that can be observed only very partially and is expressed with a high degree of subjectivity. This has led Lahire [2] to wonder whether competency frameworks can really provide a contextual and linguistic structure for describing the work of any professional – and most particularly those who interfere with people.
But, leaving aside their usefulness as a tool, we might question the very idea that competencies are suitable for use as a basis for assessment, since they are now seen as the standards needed by the future professional to perform successfully.
Competencies - An Educational Paradigm Shift
The current changes affecting the notion of competency are a response to the competency-based approach to learning, where assessment focuses on evaluating how well learners can use various resources to handle problematic situations.
Although the various authors all nuance their definitions, they generally agree that competency means using diverse resources effectively in a complex situation. But rather than being just a new development in educational practice, introducing competencies results in a whole new paradigm shift, or even, as asserted by Jonnaert [3], a true paradigmatic revolution.
A Controversial Idea
Education specialists are far from reaching a consensus about the notion of competency, which becomes a source of considerable tension. According to some authors, it has more to do with a behaviorist rationale combined with a transmissive approach, whereas others feel it has a socio-constructive dynamic [3]. One of the points raised is that competencies are hard to asses. Tardif [4] emphasizes the need for cognitive models of competencies in order to design appropriate tools for learning and assessment. While the idea of competencies provides a way of rationalizing work and postulates improved effectiveness when working, some authors nevertheless recall how the notion developed in parallel with the management methods that emerged in the 1980s and the management ideal that targeted competitiveness and profitability before all [1].
From an educational point of view, the commonly recognized definition of competency as being someone’s ability to deal with an unusual, complex situation by using the appropriate resources correctly, engenders a tension between learning and assessment. The accent is on the ability to transfer resources, or ‘mobilisation skills’ and this appears to take place to the detriment sometimes of a certain epistemological dimension that is vital to the development of professional knowledge [5]. Another problem arises when the notion of competencies is used in connection with people-centered professions like nursing. The work of professionals such as these requires a dual register of competencies: one for techniques and procedures and the other for people-skills and communication. A competency is supposed to be both observable and measurable, but many aspects of human relations do not lend themselves to being defined by objective indicators. This might explain the predominance of technical competencies in the frameworks.
CONCLUSION
The competency-based approach is a very valid one and is intended to be a particularly good way of adapting teaching and learning to practice. Nevertheless, we must take two major precautions if we are to ensure that this paradigm shift in educational establishments does not over-value the curative aspect of the profession whilst neglecting the caring and interpersonal aspects [6]. Firstly, educational institutions must ensure they have the means of implementing a competencybased approach properly. Secondly, a competency, because it has such a strong focus on technical acts and efficiency, cannot be the only basis for our students’ learning path. Teaching staff must also have tools that address student reflexivity more broadly, so as to develop the epistemology of the discipline and help to build the identity of our future professionals. The student portfolio is a tool that has a key role to play in promoting personal reflexivity and developing individual identity as the course progresses. In addition, practice analysis sessions in small groups of peers [7] offer an excellent opportunity to encourage the professionalization process, while the aim of tutoring is to individually help students with the support and guidance of a kind tutor.
This is the price that educational establishments must pay in order to maintain an educational coherence that will allow them to produce professionals who are not only competent in their practice but also are firmly rooted in their professional identity.
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