The competencies have implications for health professionals working in nursing homes, hospitals and primary care. However, like many such initiatives their implementation is not mandatory.
It is interesting that the two-year project to produce the competencies relied on support from industry, which funded a conference to launch them and series of roll-out workshops during 2008. Without this partnership it is unlikely that these competencies would reach the people who need to put them into practice.
Concerns were raised at the launch that while the competencies are intended for a multiprofessional audience they have been branded with the RCN logo. These are not exclusively nursing competencies and it is essential that they reach physiotherapists, occupational therapists, midwives, health visitors and doctors. All these professionals play essential roles in the promotion of continence and the management of continence problems. Their respective professional bodies must be involved in disseminating the competencies to ensure they reach their intended audience.
We are told that competencies can, among other things, improve patient safety, help with team-building, match competent staff to patient requirements, recognise what a post-holder does and help to target resources. When I think about competencies I think about efficiency and effectiveness which are essential in the safe delivery of care. However, competencies look at a function that an individual carries out, such as catheterisation. They do not address the way that function fits in the patient’s care plan or tell us the grade of staff required to do it. We need to be careful that, when we look at functions, we do not lose the overview of the patient.
The challenge to health professionals is to use the competencies but ensure we do not generate a task-based system with a host of healthcare workers carrying out specific tasks for the same patient. Fragmenting care in this way can lead to problems.
Competencies must be woven into and become an integral part of an existing philosophy of holistic care. Staff need to know how functions can be put together so that patients receive personalised care from people with clinical expertise who understand their needs. That is the challenge for continence services.
Eileen Shepherd, editor, Continence Journal