Modern Concepts of Skill and theirApplication to Nursing and LifelongLearning

Dr Cathy Doggett

Mrs Jan Firth

International Perspective

• ‘A key goal of nursing education must be the preparation of well educated registered nurses to meet global workforce needs with the capacity to make scientifically sound contributions to health outcomes for recipients of nursing care through provision of quality care’ (Daly, Macleod-Clark, Lancaster, Bednash, Orchard 2008).

Modernising Nursing Careers; Setting the Direction (DH 2006)

• ‘Any Healthcare system needs nurses who are intellectually able and emotionally aware and who can combine technical clinical skills with deep understanding and ability to care, as one human to another. This is the constant of nursing...........it is our promise to society.’ Beasley (2006)

A Skilled Workforce

• Central to the improvement of quality of care is a workforce enabled and empowered to deliver the best care possible (Holland 2008), this applies to wherever the nurse is practising and to achieve this an effective framework for skill development is required.

UK Context

• Current Nursing and Midwifery Council review of pre registration nursing

• Consultation on proposed changes to current Standards

• All graduate profession• ‘the combination of skills, knowledge, attitudes,

values and technical abilities that underpin safe and effective nursing practice and interventions’ adapted from the Queensland Nursing Council 2009,

The Nature of Skilful Capability

Particularly relevant to nursing which:• is fundamentally about the promotion of well being and

independence• comprises a multiplicity of skills• typically has levels of embedded goals and sub goals,

both mental and physical as in Tomlinson’s (1995) notion of Hierarchical embeddedness

Defining Skill

• Skill is a relatively consistent ability to achieve a particular kind of goal through action in/on relevant kinds of contexts (Tomlinson 1995)

• Skills are identified through their goals, action processes and/or contexts, varying from physical capabilities to those of an intellectual nature.

Nursing Skills

On the definition used nursing;

• qualifies as a form of skill• it is a purposeful caring activity• it involves the assistance of persons in the performance of activities

they would accomplish unaided if they had the necessary resources• it promotes well being• it can be done effectively or ineffectively• one can be good or bad at it generally or in particular areas• effective skill development is essential as ultimately their skills or

lack of them have important implications on standards of care and thus patient/client safety

Characteristics of skill

• skilled action is characterised by the fluency, economy and ease with which goals are achieved

• expert performance looks fluent, seamless and simple• feels relatively effortless to the performer

University of Huddersfield

Work on the premise that the strategic nature of skill brings out the fact that it is;

• knowledge based

A skilful nurse;

• has ‘know how’ having a procedural of what to do• knows when to do it and how it works ‘knowing that’ or ‘declarative knowledge’

All integrated in a skilled performance recognising that such knowledge and action can be deployed at different levels of awareness

Skilful action looks seamless and simple but is complex

An understanding of the nature of skill has been considered by us in developing our framework

Applicability to Nursing

• Government and Statutory Body Reports in UK at turn of century suggested lack of skilful capability in newly qualified nurses

• New strategies introduced• University and practitioners strengthened partnerships• Successfully planned skill development• A continuum for a career

Local Context;Incremental Approach

Based on;• Long standing evidence that skill acquisition requires

meaningful or experimental ‘practice’• Repeated attempts that are planned and corrected

through appropriate feedback• Simulation in a safe and controlled environment • Follow up practice in the real world under supervision• A continuing development framework

Our Facilities

• Six bedded ward area

• Critical care area

• Theatre

• Community room

• Children ward

• Snoozlem room •

Strategic Stakeholders

Service Providers

Commissioners

SHA

DH

Service ProvidersService Providers

CommissionersCommissioners

Strategic Health AuthorityStrategic Health Authority

Department of HealthDepartment of Health

Reference: Workforce Ambitions 2009-2014 Reference: Workforce Ambitions 2009-2014

NHS Yorkshire and the Humber (adapted)NHS Yorkshire and the Humber (adapted)

Pre qualifyingFramework

2300 hours theory; 300 hours simulation; 2000 hours practice

↓

Year 1 Practice module 1 and 2 (simulation and practice)

↓

Year 2 Practice module 1 and 2 (simulation and practice)

↓

Year 3 Practice module 1 and 2 (simulation and practice)

Continuing Professional Development (CPD)

CPD

∕ \

short courses awards e.g. nurse prescribing ∕ | \

wound debridement bachelor master doctorate

cervical screening \ ∕

professional studies/health studies

Benefits of this Approach

• All modules mapped, evaluated and revised

• Effective partnerships

• A career continuum

• Flexibility and adaptability