A review of literature by the author has recognized three approaches to competence and its assessment. The behaviourist or performance-based, focus is on what one can do but not what they know. It portrays a mechanistic approach to gaining knowledge with no rationale of interventions taken. The generic approach defined by McClelland 1973 (cited in McMullan, Endacott, Gray, Jasper, Miller, Scholes & Webb, 2003) as broad clusters of abilities, which are conceptually linked as attributes of expert performance. The flaw of this approach is that the underlying attributes can be used in any situation. The holistic approach defines competence in practice as constantly evolving relationship between performers, actions and culture. The notion of competence is therefore dynamic, with changing meanings, relational by bringing together complex combinations of attributes (Burns&Bulman, 2000). It incorporates the idea of professional judgment – experience and reflection on that experience.
Learning is referred to by Richardson, (1995) as a comprehensive, reflective practice. Reflecting on our experiences encourages learning through practice, an engagement in which we come to know ourselves and the world around us. The author has utilised this reflective approaching to learning in my nurse-training course. As an adult learner I have come to the course with previous experience, which I have not made redundant but am utilizing, in my current studies, interpersonal issues and their social context. Boud et al (1985) considers reflection to be a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to new understandings and appreciations. Reflective practice therefore allows nurses and other professionals to learn from experience. This offers the practitioner opportunities to change their own perspectives, practices and interventions in positive and explicit ways. To increase and uphold competence this approach to learning has benefits for the nurse, patient and the profession in quality of care and measure nursing outcomes.
As a nursing student the portfolio is used in assessment of my learning and competence in the nursing education. In this holistic approach to competence I have been taught to utilise reflection as a basis of developing my professional judgment, using Kolb’s (1983) experiential learning cycle (Fig.1).
FIG.1. Kolb’s Experiential learning cycle
The portfolio approach has integrated well with me as an adult learner. Most of our learning is self-directed, I am recouping my past experiences as a rich source for learning, my eagerness to acquire new skills as I tackle real life tasks and problems. Garrison (1991) (cited in Burns& Bulman, 2000) asserts that learning through reflection is a learning technique mostly suited to the adults who have a wealth of past experience and an intellectual maturity to cope with autonomy, differing perspectives and shifting ideas. This reflection can either be reflection-in or reflection-on action (Schon, 1987). Though the formal training I am receiving now as a student nurse is providing me with the technical knowledge needed to provide competent care to patients it has also proved to be a good start building competence and am using it for my professional and personal development.
By its continuous nature and structure I am managing to use it as a catalyst for my personal growth as I learn to perfect my write skills, communicate on paper and most importantly develop self-reflection. By utilizing a reflective approach to my nursing education I have over the years slowly became intuitive. Experience of observing interventions of qualified nurses and also doing them under supervision now enables me take decisions or give interpretation on the basis of my gut feeling. These have made me more assertive and grow in confidence in my interaction with patients and my colleagues.
As I come to the end of my formal nurse training but lacking in professional experience, the experience I have gained is starting to form the foundations of a framework that can guide my future decisions and actions. The progression of skills acquisition for a nurse begins from a novice level to an expert (Benner, 1984). This reflects the growth in competence to do clinical tasks and interventions built over years of hands on technical experience and reflecting on that experience to perfect patient care and professional development. Administration of medication is a particular point I have managed to partake and reflect on in all my clinical placements. As a novice nurse I had been trained in the theoretical aspects of patient care but had little if any experience in effectively communicating with patients. Now as an advanced beginner, I have observed more experienced nurses persuading patients to accept the medication offered. I have now developed and am still developing a repertoire of positive statements and argument, as well my own style of communicating with patients. Now as an advanced beginner I have acquired the necessary technical knowledge as well as some experience in recognizing when patients may need the medications authorized for them. Integrating the ability to persuade patients to accept the medication has resulted from the combination of training, experience and reflection on those events I have observed during the course of my training so far.
Of course formal training sessions can be useful in maintaining awareness of the need for reflection in the process of gaining experience, but the actual work of that reflection occurs at the time of an event and shortly after. Subsequent events may either confirm or contradict the nurse’s original position, and it is left to the nurse to reconcile both confirmation and contradiction of the nurse’s original position.
The practicing nurse needs to be encouraged to practice ongoing reflection of events that occur with patients, and s/he needs to have access to continuing education that can further inform nurses’ work in reflection processes.
Nursing is a work of art created by the nurse using all forms of knowledge and its tools. It is unique to each nurse creating it and the patient receiving it. The central concern for nurse is clinical practice and to uphold their responsibility and accountability to the governing body. Formal training provides the technical knowledge needed to provide competent care in the care giving setting, but formal training also can be seen as only the beginning point of building competence. Experience and reflection on that experience are critical factors. Years of experience with patients tempered with continual reflection on events, conditions, and actions and results the competent practitioner of the highest order.
REFERENCE
-
Boud,D.,Boud,D.&Keogh,R (1985).Reflection: turning experience into learning practice. Kogan Page.
-
Kolb, D.A. (1983).Experiential learning : experience as the source of learning and development.
-
Bailey,J. (1995).”Reflective practice: implementing theory”. Nursing Standard. 9(46).p.29-31
-
Richardson,R. (1995).”Humpty Dumpty: reflection and reflective nursing practice”. Journal of advance nursing. 21(6) p.1044-1050
-
McMullan,M.,Endacott,R.,Gray,M.A.,Jasper,M.,Miller,C.M.L, Scholes,J.&Webb,C. (2003).”Portfolios and assessment of competence:a review of literature”.Journal of advanced nursing. 41(3). P.283-294
-
Burns,S & Bulman, C.(2000). Reflective practice in nursing:the growth of the professional practitioner. (2nd ed.).Blackwell Science.Paris
-
Fearon, M.(1998). “Assessment and measurement of competence in practice”.Nursing Standard. 12(22).p.43-47