Developing a competency framework for critical care to match patient need

doi:10.1016/S0964-3397(03)00030-2

Intensive and Critical Care Nursing

Volume 19, Issue 3, June 2003, Pages 136-142

https://doi.org/10.1016/S0964-3397(03)00030-2 Get rights and content

Abstract

The competency framework developed by the critical care education group of the London Standing Conference aims to serve every grade and level of practitioner. It is neither time specific nor static. The patient is the central focus of the framework and the elements of competence reflect patient need at any critical care level [Comprehensive Critical Care: A Review of Adult Critical Care Services, The Stationary Office, London]. A group of expert nurses have developed the competency framework, with widespread consultation and collaboration. This approach intended to develop consistency for critical care education and practice. It is envisaged that this will reduce pockets of repeated activity, which places huge demands on limited resources. The critical care competency framework was developed using the method of functional analysis. A plan for the future has been identified, including continued collaboration and consultation with Trusts and Higher Educational Institutions and the development of an online manual to support the competency framework.

Key points:

•
Critical care delivery has been under close scrutiny and a number of key contemporary drivers have led to the development of this competency framework.
•
The development of a consistent pan-London approach to critical care education has been identified.
•
The patient is the focus of critical care delivery and therefore patient need is central to the critical care competency framework.
•
Wider collaboration is needed with other agencies and groups to prevent the repetition of work already carried out.

Introduction

By 2004 all nurses working within an acute care environment should have developed high dependency nursing skills (DoH 2000a, DoH 2001). The content or delivery of this training is not specified, so it is left up to individual Trust’s and educational providers to interpret this to match the needs of patients and nurses. The aim of this paper is to introduce a competency framework for nurses working in acute care areas. It represents work undertaken by practitioners, managers and educationalists over the past two and a half years. This working party forms the critical care education sub-group of the London Standing Conference (LSC). Although the work of this group is confined to a specific geographical area, widespread representation was sought to enable it to be generalised and thus applicable to similar groups within the United Kingdom.

The paper will discuss the formation of the group and identify the key contemporary driving forces that underpinned the development of the competency framework. The methodology for framework development and its constituent parts will be explored. Important links have been recognised and developed with other individuals and bodies to ensure a consistent, cohesive and user-friendly document.

Section snippets

The London Standing Conference

The LSC has been established since April 2000 forming part of an initiative to involve practitioners and enable them to have direct access to policy makers at a regional and national level. Originally 9 streams were identified, this has now increased to 15 (Table 1) and the work of this group is part of the Critical Care stream. The aim was to meet with like-minded professionals to discuss issues that were affecting critical care education and practice. The decision to focus on a competency

Key contemporary drivers

There are a number of key contemporary drivers that have led to the sustained concentration on competency development. Making a Difference (DoH, 1999) and Fitness for Practice (UKCC, 1999) highlight the need to develop outcomes within a competency framework. Competence is the skills and ability to practice safely and effectively without the need for direct supervision (UKCC, 1999). New pre-registration programmes are designed around outcome competencies, which are open to interpretation. The

Developing the competency framework

The critical care competency framework was developed using the method of functional analysis. This is a process whereby practitioners analyse their practice. It allows the practitioner to focus on what they actually do by means of a three-stage process (Eraut, 2000, p. 188):

1.
Deciding on functional units of competence
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  This involves deciding on key roles undertaken by a competent critical care nurse.
2.
Deciding on the elements of competence
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  The elements form the basis of standards against which

Establishing links and achieving a pan-London approach

From an early stage the group worked hard to develop a pan-London approach, as with any new project the need for comprehensive representation across London was considered essential. Over the months the group evolved and links were made with key people known to be either interested or involved with competency based frameworks. For example, the ongoing work of McKinley (2001) and the development of critical care competencies to support a critical care course as part of the West London

The future

An action plan for the future has been identified. This includes a proposal for a project lead to take this work forward and to collaborate with the Trusts and Higher Education Institutes. In spite of a dearth of literature available (Confederation of Australian Critical Care Nurses 1996; Fitch et al. 1996, Scribante et al. 1996, Underwood et al. 1996, Dunn 1992), there are few publications to support the notion of competency-based frameworks (Milligan 1998, While 1994, Short 1984). It is our

Conclusion

The competency framework developed by the critical care education group of the LSC aims to serve every grade of practitioner. It is neither time specific or static. The framework is designed to be used by nurses to direct their practice as they move along the continuum. A newly qualified nurse may concentrate on the dimension as a novice, whilst the more experienced nurse may concentrate on quality progressing from proficient to expert (Benner, 1984). The critical care competency framework was

Suzanne Bench RGN, BSc (Hons), PG Dip HE, ENB 100, Lecturer in Critical Care Nursing at Kings College London, London, UK

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Suzanne Bench RGN, BSc (Hons), PG Dip HE, ENB 100, Lecturer in Critical Care Nursing at Kings College London, London, UK

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Original articleDeveloping a competency framework for critical care to match patient need