Care Competence in Nursing Education

Keywords::

• nursing education
• competence
• critical thinking
• competence-based education

We present this commentary to discuss the main European initiatives and issues regarding education for health professionals, specifically nurses, both to stimulate international debate and to learn more about what is happening in this field in other continents.

The topic discussed in this article is of extreme interest for nurses, especially during this particular phase in the development of education of health professionals, because it needs to change its paradigm, which is currently focused on problem-solving competences, and start looking at building systemic competences.¹

In this challenge, nurses play a key role, not only because they are the largest health professional group but also because they are the only ones who provide care to patients on a 24/7 basis. In the twenty-first century, health systems are asking education institutions to provide adequate and uniform responses to rapid epidemiological, demographic and environmental transition. This challenge was initially addressed by the European Ministers of Education from 29 European Countries in 1999 thus giving life to the so-called Bologna Process, whose aim was to create a European Higher Education Area by improving academic degree standards and making them more compatible throughout Europe. Then, in 2000, the European Council devised the 10-year Lisbon Strategy with the purpose of making the European Union (EU) the ‘most competitive and dynamic knowledge-based economy in the world by 2010’. The Directive 2005/36 of the European Parliament and Council focused on the recognition of professional qualifications following the European Commission's Communication ‘New Skills for New Jobs. Anticipating and matching labour market and skills needs’² that warned against the persisting mismatches in the EU labour market and that the potential of labour mobility was not sufficiently exploited. Thereafter a debate was begun leading to the recent Proposal for the Modernisation of the Directive 2005/36/EC.³ In addition, in 2008, the Green Paper on the European Workforce for Health⁴ stimulated further debate across Europe leading to the conclusion that by 2020, approximately another 1 million health workers will be needed in the EU to respond adequately to the new challenges of the health systems.

This situation in Europe has generated the need to define common principles among higher education institutions to ensure the quality of education by proposing a common framework based on competences.⁵

The European Qualifications Framework classifies learning levels into three categories: knowledge, skills and competences. The third category (competences) is currently at the centre of European and international debate on professional qualifications among various stakeholders, competent authorities, professional organisations, European networks like the European Council of Nursing Regulators (FEPI), the European Council of Liberal Professions (CEPLIS), the International Council of Nurses (ICN) and the European Federation of Nurses Associations (EFN). These organisations largely include representatives of professional regulatory bodies, whose objective is also to set the standards of education, including those of health professionals. Moreover, in terms of the educational curricula, they are suggesting the introduction of an optional, alternative educational framework legally recognised throughout the EU, known as ‘28th Regime’ (also known as ‘European Degree’), which offers an additional curriculum to the one that already exists in each country and is based on EU educational standards. This idea was launched on the 7th of January 2011 by the European Commission.⁶

Another initiative, evolving towards the uniformity of competences in health professionals, is the Tuning Educational Structures in Europe Project⁷ started in 2000 with the general aim of finding common points of convergence among universities and, in particular, to define the general health professional competences provided by university degree programmes and the specific competences linked to each discipline, including nursing. General competences are classified as instrumental, interpersonal or systemic competences. Systemic competences require the development of complex skills, which help to respond to systemic issues, such as improving health care in terms of continuity, caring for increasingly complex and chronic patients, and going beyond the merely technical health-care action by developing a contextual response.

According to this European perspective, nursing education will need to adapt its core competences to specific contexts and implement the shift from knowledge-based systems or problem-solving systems to educational systems based on systemic competences based on critical reasoning and aimed at transformative learning.⁸

Critical thinking is an essential component for health professional competences⁹ because these competences offer a response to health systems that enshrine a productive interaction between a team of pro-active professionals and an empowered population of patients.¹⁰

Promoting critical thinking in nursing education is an important way to improve the solution of health care problems, decision-making and the quality of care provided to patients.¹¹

The development of critical thinking competences for nurses requires appropriate teaching environments (i.e. universities, academic institutions). Nursing education outcomes should include not just systemic competences but also the expectations of the patients for whom they care.

Education provided to health professionals and, in particular, on-site training should adjust curricula by using methods for teaching and testing performance skills, such as decision-making, clinical judgement and the solution of complex health-care problems.

Declaration of interest

Funding

No commercial support was provided for this manuscript.

Author(s) Financial Disclosure

A.B. has disclosed that she has no relevant financial relationships.

F.R. has disclosed that she has no relevant financial relationships.

G.A. has disclosed that he has no relevant financial relationships.

L.S. has disclosed that she has no relevant financial relationships.

Peer Reviewers Financial Disclosure

Peer Reviewer 1 has disclosed that he/she has no relevant financial relationships.

Peer Reviewer 2 has disclosed that he/she has no relevant financial relationships.