Cancer and Palliative
Care Competencies:
Empowering or
constraining
Mr. R Becker
Macmillan Senior Lecturer in Palliative Care
Staffordshire University and Severn Hospice Shropshire England
“Eighty percent of success
in life is related to attitude
rather than competency”
Anon
Competencies can be seen as…
• A universal panacea which
will revolutionise skills
based training and
education
• The Emperors new clothes
What is competency?
“The skills, knowledge,
experience, attributes and
behaviours required by an
individual in order to
perform the job effectively”
(RCN 2002)
The core skills of palliative care
nursing
1. Communication skills
2. Psychosocial skills
3. Team skills
4. Physical care skills
5. Life closure skills
6. Intrapersonal skills
Becker R (2000) Competency Assessment in Palliative Nursing . European Journal of
Palliative Care. Vol 7. No 3. Pages 88 – 91.
A comparative view of the skills development of district
nurses using a competency assessment tool
COMMUNICATION SKILLS
100
80
Explored
60
Practiced
40
Developed
Mastered
20
0
Baseline
Final
Designing a competency
statement
The core components:
• Knowledge
• Skill
• Behaviour/attitude
Examples include:
• K - Discuss the concept of total pain and
it’s relevance to patient centred care in a
palliative context
• S - Conduct a pain assessment interview
using a range of available frameworks
and tools
• B/A - Demonstrate and articulate an
active commitment to the holistic
assessment of pain
Complex statements that involve
reflection and professional maturity
• Demonstrate respect for the inherent worth of
others, coupled with a predisposition to look for
the good things in people, and an intrinsic
belief in this
• Recognise and attempt to understand your
own reactions and feelings when caring for the
dying and bereaved, reflecting on how this
affects the care given in sensitive situations
I now see myself more as my peers see me, some
of this I like and some of this I was surprised about.
I know I am judgemental and I have been working
with someone who isn’t, to try and improve and learn
By focusing on how competent others see you it
gives you another perspective on your own abilities.
Honesty is everything.
I was told that I was not as good at listening as I
thought. I was afraid of silence and I needed to
practice this more. I never realised.
Becker R (2000) Competency Assessment in Palliative Nursing . European Journal of
Palliative Care. Vol 7. No 3. Pages 88 – 91.
KNOWLEDGE COMPETENCE
COGNITIVE/ANALYTICAL
COMPETENCE
TECHNICAL
PSYCHOMOTOR
COMPETENCE
PERSONAL ETHICAL,
BEHAVIOURAL
COMPETENCE
AFFECTIVE
COMPETENCE
INTRAPERSONAL
COMPETENCE
Becker R (2007) Ch 2, The use of Competencies in Cancer and Palliative
Education, in Foyle L & Hostad J (2007) Innovations in Cancer and Palliative Care
Education, Radcliffe Press
Integrating Competencies?
• USA – Robert Wood Johnson Foundation
(Ferrell et al 1999)
• Medical Education . (Pall Med Curric
1992)
• Nursing ? Ad hoc (Lloyd Williams & Field
2002)
• Allied Health Professionals ? Ad hoc
(Becker 2007)
The Notion of Competency Assessment
“There is a climate of uncertainty
amongst nurses, who are confused
and overwhelmed by the proliferation
of methodologies presented to them,
which are often written in educational
language that they are unfamiliar
with.”
Becker R (2000) Competency Assessment in Palliative Nursing. European Journal of
Palliative Care. 7. (3) p88-91.
The way forward?
Universities, Educators and
professional bodies:
• Identify appropriate modes for
education delivery
• Education and training commissioning
with local providers
• Facilitate competency acquisition in the
workplace –work based learning
• Provide uniform, clinically relevant and
standardised content for cancer and
palliative care education programmes.
Individual practitioners:
• Plan and develop their career pathway.
• Identify their own training and
education/skill requirements.
• Access appropriate education initiatives
• Self-assess performance in relation to
Individual Performance Review (IPR) and
the development of a Personal
Development Plans (PDP).
Managers:
• Assessing ongoing competency as part of the
IPR process.
• Informing future roles and responsibilities, job
description and person specification
development (DOH 2005)
• Measuring competency within a team to inform
skill mix review and staffing establishment.
• Identify workforce training needs.
• Monitor progress for achieving national targets
and standards.
...”When we speak of challenges we must not
forget that of teaching and enthusing our
professional colleagues and students. I suspect
we have got it wrong. We are filling the syllabus
with doses and data when we should be trying to
change attitudes.
Wherever I travel in the world I find palliative care
workers who feel they must justify their
existence, particularly if they have specialist
status, and they do so by parading facts and
figures rather than sharing some of the profound
insights which so characterise palliative care…..
Derek Doyle 1999 Farewell Address. Geneva.
Thank you
for listening
Mr. R Becker
Macmillan Senior Lecturer in Palliative Care
Staffordshire University and
Severn Hospice, Shropshire, England
E mail: bobb@severnhospice.org.uk