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Transcript of Ashworth and Morrison reply
70 NURSEEDUCATIONTODAY
also aspects of knowledge, understanding and affec- tive 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 super- vision 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, circum- stances 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 encom- passing much more. Perhaps one of the best defi- nitions, 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 organ- ization and planningofwork, innovation and coping with non-routine activities. It includes those quali- ties 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 competence- based 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 and improve professional knowledge and 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 ION TODAY 71
paper). If so, there are plenty of other official docu-
ments which definitely do use the term technically. For
instance, the ENB Framework for Continuing Pro-
fessional 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 know-
ledge 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 con-
trasting 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 diffi-
culty 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 behav-
iour. 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.
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 mechanis-
tic 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 (appar-
ently unbeknown to him) actually precisely reinfor-
cing what we are arguing. The whole of the paragraph
about the distinction between the ability to do some-
thing 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 imagin-
atively 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 such grave
doubts, is the lynchpin of this movement.
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 competence- based 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
‘7,
Wolf A 1989 Can knowledge and competence mix? In: Burke J W (ed) Competency based education and training. Falmer Press, Lewes