Once upon a time, competencies were developed for health care providers in palliative and end of life care. There were competencies written for nurses, health care workers (nursing assistants, personal support workers, hospice aides), physicians and social workers, and others. There were competencies developed in many lands, in Ireland and the United States, in Nova Scotia and Alberta, in Ottawa and Vancouver, to name just a few. After creation, competencies struggled to be heard and adopted and too often were not used to inform curriculum or education development.
According to the Palliative Care and End of Life Working Group (2009) in their article, Competency-Based Education Approaches in Palliative and End-of-Life Care in Cancer, sponsored by the Canadian Partnership against Cancer, (pp. 15) they suggest that competencies may not have been adopted because they were misunderstood as being the same as “goals” or “learning outcomes.” In other places, it is possible that they were not adopted because there was confusion about how to define the competencies1.
And it is possible that certain educators, (myself included), just did not know where the competencies were, and that they could be incredibly helpful, inspiring and an essential resource for planning and developing education and educational materials.
For me, it was exciting when hospice palliative end-of-life care (HPEOLC) competencies came to life in my heart and in my hands. Here is my story:
I was writing a book – a textbook (Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse). I wanted the text to be useful for nurses in Canada and the United States. I wanted the text to help prepare students to meet the national competencies set for registered and practical nurses.
At first, I took the competencies and put them in a table format. I compared the competencies. I looked for differences and I looked for similarities. I went cross-eyed and just about went nuts.
Then I took one set of competencies, spread them across a football field (also called a mind-map). Then I took competencies developed by other groups and placed them individually, alongside other like-minded competencies. Eventually all the competencies were grouped together.
I returned to the outline for my textbook and asked myself whether to, and how to address the competencies in the text. Then I researched and I wrote. A few months ago, the textbook, Essentials in Hospice and Palliative Care: A Practical Resource for Every Nurse was published. Competency based, competency driven, competency inspired.
Now, we (myself and my great team) asked, “What types of companion teaching and learning resources can we develop that will help nurse educators to teach the different members of the nursing family to meet their respective competencies?” and “What can we do to help educators integrate hospice and palliative care in core curriculum?”
On a personal level, as a new year begins, I returned to the competencies to help me reflect on my practice and determine what I need to learn, and what I need to do to improve my practice. The competencies guided me in my writing, and now inspire me in my personal professional reflection.
Following is a list of the competencies that I refer to when planning education, and is the list of competencies that I refer people to when they are looking for HPEOLC competencies.
My Favorite Competency Documents
There are differences in the competencies written by different professions in different countries and for different purposes. Each group has a unique way of articulating, formatting, prioritizing and organizing. I think that most of the competencies represent similar knowledge, skills, and attitudes. Regardless of whether you align with competencies for this group or that group, this country or that country, all the competencies guide health care providers toward similar outcomes. While you may be required to use a set of competencies designed in the area where you work, it is also possible that you may still be inspired by the competencies developed outside of your area. There are provinces and states that have not identified competencies related to hospice palliative end-of-life care for members of the health care team or have very limited competencies. If you are in such an area, you may find one of these documents helpful.
A guided tour of the competency documents that I refer to in my practice
These competency documents help me when planning education, reviewing, and reflecting on education, and reflecting on my own practice. The competencies may be of help to you as you identify what you want to address in education that you are planning. I hope this list of resources is helpful to you in your work.
Nursing Competencies in Canada
CASN identified competencies and indicators for educating Registered Nurses in their document, Palliative and End-of-Life Care: Entry to Practice Competencies and Indicators for Registered Nurses. Their goal is for Canadian colleges and universities to use the “ … competencies may provide direction to curricula development; indicators may be used by nurse educators and students as a guide for assessing the development and integration of a competency.” 2
In Alberta, Canada, the College of License Practical Nurses of Alberta wrote that a “profession has strength when their contribution is clearly articulated. For the Licensed Practical Nurse profession in Alberta, this articulation is seen in competencies and education that outline the knowledge, skill, behaviors, judgments and attitudes that are expected of the profession.” They updated and launched their hospice palliative and end of life competencies in 2015. These competencies are clear and concise and may be very helpful as you prepare and evaluate education for practical and vocational nurses.
Personal Support Workers in Canada
The Canadian Association of Continuing Care Educators launched the Canadian Educational Standards for Personal Care Providers in 2012. The Ontario Ministry of Training, Colleges and Universities published the Personal Support Worker Program Standards in 2014, which includes learning outcomes related to palliative and end-of-life care, and accompanying performance objectives.
In a Canadian research study, a group of Personal Support Workers serving as palliative care champions in their facilities developed the Quality Palliative Care in Long Term Care Alliance Personal Support Workers Competencies. These more advanced competencies may be most useful in developing continuing education for experienced PSWs.
Nursing Competencies in the United States
The American Association of Colleges of Nursing approved the end-of-life care competencies developed by ELNEC, that are available in the 2017 document, Peaceful Death: Recommended Competencies and Curricular Guidelines for End-of-Life Nursing Care. ELNEC identified entry level competencies for Registered Nurses. In this same article, they identify content areas where the competencies can be taught in a nursing program.
Nurses and Nursing Assistant in the United States
The Hospice Palliative Nurses Association provide advanced certification for Nursing Assistants, Practical/Vocational Nurses and Registered Nurses and Registered Nurses working with children. Competency documents and study guides are available for each of these groups.
Interprofessional Competencies in Ireland
The Irish interprofessional team identified competencies that the entire health care team share as well as identifying those that are profession specific in Palliative Care Competence Framework. Currently there is a team in Canada that is finalizing their interprofessional competencies. I will add them to this list when they are approved.
Now, my question for you: What competency resources do you use to guide your work?
- The literature has found that educators have been attempting to accurately define the notion of competence for several decades and have not yet reached agreement. Many authors argue that this confusion in what actually constitutes competence is what has slowed down the progression to competency-based education. … what makes matters even more confusing is that it is difficult to separate a competency from what have been called goals and objectives, and in fact many competencies that have been developed tend to be a combination of what others may call goals and objectives.” Palliative Care and End of Life Working Group (2009). Competency-Based Education Approaches in Palliative and End-of-Life Care in Cancer, Canadian Partnership Against Cancer, pp 15.
- Canadian Association of Schools of Nursing (2011). Palliative and End-of-Life Care Entry-to-Practice Competencies and Indicators for Registered Nurses.