- Email: [email protected]
Ashworth and Morrison reply
70
NURSEEDUCATIONTODAY
also aspects of knowledge, understanding and affective or interpersonal skills. Thinking is not, as the authors maintain, treated in a superficial way by the advocates of competence; it can have much more than the limited function they suggest and can, together with knowledge and understanding, be built in as an essential integral part of any competence. Wolf and Mitchell (1991) deal with this issue at length and state that the assessment of knowledge and understanding ‘must be approached within the complete context of evidence collection and not as a separate enterprise’. Being able to do something and being able to teach someone else how to do it are two different competences altogether. On any model of education and/or training they are separate abilities: for example, in terms of Steinaker and Bell’s experiential taxonomy, the nurse giving an injection under supervision will be at the participation level, while the one teaching others will have progressed to the higher dissemination level (Kenworthy & Nicklin 1989). To address the point of concern about the level of ability that must be demonstrated to show competence, this again is built into the modern competence model by the definition of standards and range statements that detail the situations, circumstances and levels of performance required (Mitchell 1989; Wolf & Mitchell 199 1). In conclusion, Ashworth and Morrison (199 1) state that ‘competence is a technically orientated way of thinking, often inappropriate to the facilitation of the training of human beings’. Dunn and Hamilton (1985), Jessup (1989), Wolf and Mitchell (1991) and Wolf (1989), however, all view competence as encompassing much more. Perhaps one of the best definitions, comprehensive if a little lengthy, comes from Debling (1989) who defines it so: ‘Competence pertains to the ability to perform the activities within a function or occupational area to the levels of performance expected in employment. It is a broad concept which embodies the ability to transfer skills and knowledge to new situations within the occupational area. It encompasses organization and planningofwork, innovation and coping with non-routine activities. It includes those qualities of personal effectiveness that are required in the workplace to deal with co-workers, managers and customers’. (pp ??) For anyone interested in reading more about competence and its use as a basis for education and training, might I recommend J. W Burke’s book.
PETERJ MURRAY BA RGN, Chester and Wirral School of Nursing and Midwifery
References Ashworth P, Morrison P 199 1 Problems of competencebased nurse education. Nurse Education Today 11: 25&160 Burke J W (ed) 1989 Competency based education and training. The Falmer Press, London Debling G 1989 The Employment Department/Training Agency standards programme and NVQs: implications for education. In: Burke J W (ed) Competency based education and training. The Falmer Press, London Dunn W R, Hamilton D D 1985 Competence-based education and distance learning: a tandem for professional continuing education? Studies in Higher Education 10.3: 277-287 Jessup G 1989 The emerging model of vocational education and training. In: Burke J W (ed) Competency based education and training. The Falmer Press, London Kenworthy N, Nicklin P 1989 Teaching and assessing in nursing practice. Scutari Press, London Mitchell L 1989 The definition of standards and their assessment. In: Burke J W (ed) Competency based education and training. The Falmer Press, London Wolf A 1989 Can competence and knowledge mix? In: Burke J W (ed) Competency based education and training. The Falmer Press, London Wolf A, Mitchell L 1991 Understanding the place of knowledge and understanding in a competence based
approach. In: Fennel E (ed) Development of assessable standards for national certification. HMSO, London
Ashworth and Morrison Reply It is always gratifying to authors to find that their work has been read and mulled over. We were therefore pleased to see the comments on our paper ‘Problems of competence-based nurse education’ from Mrs Lyn Mitchell and Mr Peter Murray. However, we feel that in both letters there are errors of fact which require correction, and that in Mr Murray’s letter there are serious misinterpretations which just cannot be left unchallenged. Mrs Mitchell plainly wishes to disown the competence model of education, and denies that the approach is receiving ‘central encouragement’ (as we asserted). But, in fact, it is. For instance, the current Code of Professional Conduct (1984) states that nurses shall “fake every reasonable opportunity to maintain knowledge and professional and improve competence’ (Statement 3). Statements 4 and 12 also explicitly refer to competence. However, it may be that these statements are not using the term ‘competence’ in a technical sense, and therefore do not entail acceptance of any specific model of competence (such as the National Council for Vocational Qualifications/Department of Employment model which we were discussing in our
NURSE EDU(:Al
paper). If so, there are plenty of other official documents which definitely do use the term technically. For instance, the ENB Framework for Continuing Professional Education (Rogers 1991), refers to Statement 3 of the Code of Conduct mentioned above, and goes on to quote with approval the recommendation of the Post-Registration and Practice Project [PREPP] Report (UKCC 1990): ‘. all nurses, midwives and health visitors should demonstrate that they have maintained and developed their professional knowledge and competence’ (~38). Both the Framework and the PREPP study on which it is based use the competence model discussed in our paper. The PREPP study is explicit about this, referring to competences in our sense in paragraphs 4.4,4.6,5.1,5.3,5.10,6.6, and 11.4.The Frameworkis more coy about the use of the word, but plainly embodies the same philosophy, couched in terms of ‘10 key characteristics which represent the key areas of skill, knowledge and expertise which all practitioners must have to provide the quality of care required’ (Rogers 199 1, p 12). From these and other documents it is plain that there is indeed central encouragement for the use of the competence approach to nurse education. We turn now to Mr Murray’s letter. Despite his assertion to the contrary, the model of competence we discussed in our paper is, regretably, the model which is currently influencing nurse education. Mr Murray points out that this model is ‘narrow and outdated’. It is-but the implication of his letter that there is a better model which nurse educators are actually using, is false. There is no such model. In fact, the references appended to his letter are precisely to the literature which we criticised in our paper. Let us assure him that we are fully conversant with that literature, and are only too well aware that much of it ‘can have a direct bearing on the use and assessment of competence from a nursing viewpoint’ (Murray 1992). Indeed, that is exactly our point, and it is the reason why it is so urgent that nurse educators should be aware of its very serious limitations. The specific criticisms which Mr Murray makes of our article indicate that it was over-hastily read. For instance, he mistakes the point of our example contrasting a nurse manager who communicates directly (being a competent communicator) with one who sensibly delegates communication to a subsordinate who is a good communicator (knowing she has difficulty in that sphere). We were showing that, though different competences are involved in the two cases, the job of communication gets done. Thus the careful specification of a set of competences, all of which are required of all people playing a certain role, is mechanistic and out of touch with real work behaviour. Mr Murray insists that communication and delegation are distinguishable competences which can be separately assessed. We know this. Our point is a much more fundamental one.
ION TODAY
71
On several occasions, Mr Murray does not give any reason at all for his disagreements with our paper, but merely asserts his different view. Thus, if we were to ask why he thinks transfer of competence from one situation to another is guaranteed. his answer would appear merely to be that ‘modern definitions of the term [competence] include the ability to transfer skills to unmet situations’. If only problems could be defined out of existence in this way! Let us just list other points at which Mr Murray substitutes mere assertion for reasoned argument. He claims, without tackling the issues rarsed in the paper, that levels of performance required can be specified (how, exactly, without encountering the problems we mention?); that competence-thinking is not mechanistic or out of keeping with human modes of action (we have shown in clear instances that it is both of these things), and that ‘personal relationship skills’ can be framed in competence terms (without answering our objection that this is entirely antithetical to the attitude of mind entailed in patient-centred care). Perhaps Mr Murray’s haste in reading our article is most clearly shown where he cites authorities on competence as if to contradict our views, but (apparently unbeknown to him) actually precisely reinforcing what we are arguing. The whole of the paragraph about the distinction between the ability to do something and the ability to teach it. is an instance of this. Similarly, he attempts to back up his assertion that the competence model is less superficial I han we say it is on the role of knowledge and understanding, with a quote which, in fact, re-emphasises the \ iew , which we are criticising: that knowledge must be assessed through performance, and is important only insofar as it relates to competence in Oing .something. The role of knowledge and understanding is still (despite a certain amount of agonismg - see Black 8c Wolf 1990: Fender & Stuart 1990; Jessup 1991; Wolf 1989) treated in a paltry way by the advocates of the competence model. They seem unable to grasp the idea that. when people know - in the sense of ‘understand’ - they have at their disposal a mental representation of the situation with which they are confronted. enabling them (for exa.mple) to imaginatively vary the situation and construe alternative possibilities (‘What if I did such-and-such .‘, ‘I wonder if this problem can be solved in a similar way to .‘) And the wider the nurses’ general knowledge and understanding, the greater the possibility that he or she will have at their disposal the relevant concepts. But such a view of knowledge and understanding is just not encompassed by the competence model. More detailed argument along these lines is provided in Ashworth (1991) and Ashworth and Saxton (1990). Of all the issues confronting nurse educators at the moment. it is arguable that getting a lull. critical grasp of the competence model is of greatest long-term importance. The National Vocational Qualifications movement is not going to disappear (there is no
72
NURSEEDUCATIONTODAY
political opposition to it), and it is currently set to develop in the direction of higher education and education for the professions (NCVQ 1989). The competence model, about which we have doubts, is the lynchpin of this movement.
such
grave
PETERASHWORTH BSc(Tech)
PhD FBPsS CPsychol, School of Health and Community Studies, Sheffield City Polytechnic,
PAULMORRISON BA RMN RGN PGCE PhD, University of Wales College of Mecicine, Cardiff
References Ashworth P 1991 Being competent and having ‘competences’. Paper presented at the Conference: Competence in Higher Education in the 1990s. Wolverhampton Polytechnic, June 1991 Ashworth P, Morrison P 1991 Problems of competencebased nurse education. Nurse Education Today 11: 256-260 Ashworth P, Saxton J 1990 On ‘competence’. Journal of Further and Higher Education 14: 3-25
Black H, Wolf A 1990 Knowledge and competence. Careers and Occupational Information Centrel HMSO, London Fender M, Stuart D 1990 Linking knowledge assessment to competent performance. Competence and Assessment 14: 3-5 Jessup C 1991 Outcomes: NVQs and the emerging model of education and training. Falmer Press, Lewes NCVQ 1989 Extension of the NVQ framework above level iv: A consultative document. National Council for Vocational Qualifications, London Rogers J 1991 Framework for continuing professional education for nurses, midwives and health visitors: Guide to implementation. English National Board for Nursing, Midwifery and Health Visiting, London UKCC 1984 Code of professional Conduct for the Nurse, Midwife and Health Visitor. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London UKCC 1990 The report of the post-registration education and practice project. Unitid Kingdom Central Council for Nursing. Midwiferv and Health Visiting, London Wolf A 1989 Can knowledge and competence mix? In: Burke J W (ed) Competency based education and training. Falmer Press, Lewes ‘7,
NURSEEDUCATIONTODAY
also aspects of knowledge, understanding and affective or interpersonal skills. Thinking is not, as the authors maintain, treated in a superficial way by the advocates of competence; it can have much more than the limited function they suggest and can, together with knowledge and understanding, be built in as an essential integral part of any competence. Wolf and Mitchell (1991) deal with this issue at length and state that the assessment of knowledge and understanding ‘must be approached within the complete context of evidence collection and not as a separate enterprise’. Being able to do something and being able to teach someone else how to do it are two different competences altogether. On any model of education and/or training they are separate abilities: for example, in terms of Steinaker and Bell’s experiential taxonomy, the nurse giving an injection under supervision will be at the participation level, while the one teaching others will have progressed to the higher dissemination level (Kenworthy & Nicklin 1989). To address the point of concern about the level of ability that must be demonstrated to show competence, this again is built into the modern competence model by the definition of standards and range statements that detail the situations, circumstances and levels of performance required (Mitchell 1989; Wolf & Mitchell 199 1). In conclusion, Ashworth and Morrison (199 1) state that ‘competence is a technically orientated way of thinking, often inappropriate to the facilitation of the training of human beings’. Dunn and Hamilton (1985), Jessup (1989), Wolf and Mitchell (1991) and Wolf (1989), however, all view competence as encompassing much more. Perhaps one of the best definitions, comprehensive if a little lengthy, comes from Debling (1989) who defines it so: ‘Competence pertains to the ability to perform the activities within a function or occupational area to the levels of performance expected in employment. It is a broad concept which embodies the ability to transfer skills and knowledge to new situations within the occupational area. It encompasses organization and planningofwork, innovation and coping with non-routine activities. It includes those qualities of personal effectiveness that are required in the workplace to deal with co-workers, managers and customers’. (pp ??) For anyone interested in reading more about competence and its use as a basis for education and training, might I recommend J. W Burke’s book.
PETERJ MURRAY BA RGN, Chester and Wirral School of Nursing and Midwifery
References Ashworth P, Morrison P 199 1 Problems of competencebased nurse education. Nurse Education Today 11: 25&160 Burke J W (ed) 1989 Competency based education and training. The Falmer Press, London Debling G 1989 The Employment Department/Training Agency standards programme and NVQs: implications for education. In: Burke J W (ed) Competency based education and training. The Falmer Press, London Dunn W R, Hamilton D D 1985 Competence-based education and distance learning: a tandem for professional continuing education? Studies in Higher Education 10.3: 277-287 Jessup G 1989 The emerging model of vocational education and training. In: Burke J W (ed) Competency based education and training. The Falmer Press, London Kenworthy N, Nicklin P 1989 Teaching and assessing in nursing practice. Scutari Press, London Mitchell L 1989 The definition of standards and their assessment. In: Burke J W (ed) Competency based education and training. The Falmer Press, London Wolf A 1989 Can competence and knowledge mix? In: Burke J W (ed) Competency based education and training. The Falmer Press, London Wolf A, Mitchell L 1991 Understanding the place of knowledge and understanding in a competence based
approach. In: Fennel E (ed) Development of assessable standards for national certification. HMSO, London
Ashworth and Morrison Reply It is always gratifying to authors to find that their work has been read and mulled over. We were therefore pleased to see the comments on our paper ‘Problems of competence-based nurse education’ from Mrs Lyn Mitchell and Mr Peter Murray. However, we feel that in both letters there are errors of fact which require correction, and that in Mr Murray’s letter there are serious misinterpretations which just cannot be left unchallenged. Mrs Mitchell plainly wishes to disown the competence model of education, and denies that the approach is receiving ‘central encouragement’ (as we asserted). But, in fact, it is. For instance, the current Code of Professional Conduct (1984) states that nurses shall “fake every reasonable opportunity to maintain knowledge and professional and improve competence’ (Statement 3). Statements 4 and 12 also explicitly refer to competence. However, it may be that these statements are not using the term ‘competence’ in a technical sense, and therefore do not entail acceptance of any specific model of competence (such as the National Council for Vocational Qualifications/Department of Employment model which we were discussing in our
NURSE EDU(:Al
paper). If so, there are plenty of other official documents which definitely do use the term technically. For instance, the ENB Framework for Continuing Professional Education (Rogers 1991), refers to Statement 3 of the Code of Conduct mentioned above, and goes on to quote with approval the recommendation of the Post-Registration and Practice Project [PREPP] Report (UKCC 1990): ‘. all nurses, midwives and health visitors should demonstrate that they have maintained and developed their professional knowledge and competence’ (~38). Both the Framework and the PREPP study on which it is based use the competence model discussed in our paper. The PREPP study is explicit about this, referring to competences in our sense in paragraphs 4.4,4.6,5.1,5.3,5.10,6.6, and 11.4.The Frameworkis more coy about the use of the word, but plainly embodies the same philosophy, couched in terms of ‘10 key characteristics which represent the key areas of skill, knowledge and expertise which all practitioners must have to provide the quality of care required’ (Rogers 199 1, p 12). From these and other documents it is plain that there is indeed central encouragement for the use of the competence approach to nurse education. We turn now to Mr Murray’s letter. Despite his assertion to the contrary, the model of competence we discussed in our paper is, regretably, the model which is currently influencing nurse education. Mr Murray points out that this model is ‘narrow and outdated’. It is-but the implication of his letter that there is a better model which nurse educators are actually using, is false. There is no such model. In fact, the references appended to his letter are precisely to the literature which we criticised in our paper. Let us assure him that we are fully conversant with that literature, and are only too well aware that much of it ‘can have a direct bearing on the use and assessment of competence from a nursing viewpoint’ (Murray 1992). Indeed, that is exactly our point, and it is the reason why it is so urgent that nurse educators should be aware of its very serious limitations. The specific criticisms which Mr Murray makes of our article indicate that it was over-hastily read. For instance, he mistakes the point of our example contrasting a nurse manager who communicates directly (being a competent communicator) with one who sensibly delegates communication to a subsordinate who is a good communicator (knowing she has difficulty in that sphere). We were showing that, though different competences are involved in the two cases, the job of communication gets done. Thus the careful specification of a set of competences, all of which are required of all people playing a certain role, is mechanistic and out of touch with real work behaviour. Mr Murray insists that communication and delegation are distinguishable competences which can be separately assessed. We know this. Our point is a much more fundamental one.
ION TODAY
71
On several occasions, Mr Murray does not give any reason at all for his disagreements with our paper, but merely asserts his different view. Thus, if we were to ask why he thinks transfer of competence from one situation to another is guaranteed. his answer would appear merely to be that ‘modern definitions of the term [competence] include the ability to transfer skills to unmet situations’. If only problems could be defined out of existence in this way! Let us just list other points at which Mr Murray substitutes mere assertion for reasoned argument. He claims, without tackling the issues rarsed in the paper, that levels of performance required can be specified (how, exactly, without encountering the problems we mention?); that competence-thinking is not mechanistic or out of keeping with human modes of action (we have shown in clear instances that it is both of these things), and that ‘personal relationship skills’ can be framed in competence terms (without answering our objection that this is entirely antithetical to the attitude of mind entailed in patient-centred care). Perhaps Mr Murray’s haste in reading our article is most clearly shown where he cites authorities on competence as if to contradict our views, but (apparently unbeknown to him) actually precisely reinforcing what we are arguing. The whole of the paragraph about the distinction between the ability to do something and the ability to teach it. is an instance of this. Similarly, he attempts to back up his assertion that the competence model is less superficial I han we say it is on the role of knowledge and understanding, with a quote which, in fact, re-emphasises the \ iew , which we are criticising: that knowledge must be assessed through performance, and is important only insofar as it relates to competence in Oing .something. The role of knowledge and understanding is still (despite a certain amount of agonismg - see Black 8c Wolf 1990: Fender & Stuart 1990; Jessup 1991; Wolf 1989) treated in a paltry way by the advocates of the competence model. They seem unable to grasp the idea that. when people know - in the sense of ‘understand’ - they have at their disposal a mental representation of the situation with which they are confronted. enabling them (for exa.mple) to imaginatively vary the situation and construe alternative possibilities (‘What if I did such-and-such .‘, ‘I wonder if this problem can be solved in a similar way to .‘) And the wider the nurses’ general knowledge and understanding, the greater the possibility that he or she will have at their disposal the relevant concepts. But such a view of knowledge and understanding is just not encompassed by the competence model. More detailed argument along these lines is provided in Ashworth (1991) and Ashworth and Saxton (1990). Of all the issues confronting nurse educators at the moment. it is arguable that getting a lull. critical grasp of the competence model is of greatest long-term importance. The National Vocational Qualifications movement is not going to disappear (there is no
72
NURSEEDUCATIONTODAY
political opposition to it), and it is currently set to develop in the direction of higher education and education for the professions (NCVQ 1989). The competence model, about which we have doubts, is the lynchpin of this movement.
such
grave
PETERASHWORTH BSc(Tech)
PhD FBPsS CPsychol, School of Health and Community Studies, Sheffield City Polytechnic,
PAULMORRISON BA RMN RGN PGCE PhD, University of Wales College of Mecicine, Cardiff
References Ashworth P 1991 Being competent and having ‘competences’. Paper presented at the Conference: Competence in Higher Education in the 1990s. Wolverhampton Polytechnic, June 1991 Ashworth P, Morrison P 1991 Problems of competencebased nurse education. Nurse Education Today 11: 256-260 Ashworth P, Saxton J 1990 On ‘competence’. Journal of Further and Higher Education 14: 3-25
Black H, Wolf A 1990 Knowledge and competence. Careers and Occupational Information Centrel HMSO, London Fender M, Stuart D 1990 Linking knowledge assessment to competent performance. Competence and Assessment 14: 3-5 Jessup C 1991 Outcomes: NVQs and the emerging model of education and training. Falmer Press, Lewes NCVQ 1989 Extension of the NVQ framework above level iv: A consultative document. National Council for Vocational Qualifications, London Rogers J 1991 Framework for continuing professional education for nurses, midwives and health visitors: Guide to implementation. English National Board for Nursing, Midwifery and Health Visiting, London UKCC 1984 Code of professional Conduct for the Nurse, Midwife and Health Visitor. United Kingdom Central Council for Nursing, Midwifery and Health Visiting, London UKCC 1990 The report of the post-registration education and practice project. Unitid Kingdom Central Council for Nursing. Midwiferv and Health Visiting, London Wolf A 1989 Can knowledge and competence mix? In: Burke J W (ed) Competency based education and training. Falmer Press, Lewes ‘7,