REMOTE AREA NURSE COMPETENCIES PROJECT TEAM
Research Team:
Associate Professor Anne-Katrin Eckermann
Dr Toni Dowd
Ms Sally Johnson AM
Ms Di Lawson
Ms Mary Martin
Co-Researchers:
Ms Vicki Gordon (NT)
Ms Karen Schnitzeling (NSW, TAS)
Ms Brenda Santi (NT)
Ms Alison Dawes (NSW)
Ms Sabina Knight (NT)
Mr Chris Gill (Qld)
Ms Gail Freeland (WA)
Ms Susan Green (SA)
Program Management Committee:
Mr John Anderson (DHFS)
Ms Margaret-Ann Cook (AHMAC)
Ms Jill Iliffe (ANF)
Ms Isabelle Ellis (CRANA)
Ms Colleen Prideaux (NACCHO)
Ms Margaret McLean (ANF)
Ms Mandy Pusmuscans (CRANA)
Ms Karen Freedman (OATSIHS)
Remote Area Nursing: The Challenge of Competence Video Team
Toni Dowd
Brenda Santi
Sally Johnson
Anne-Katrin Eckermann
Supported by Debra Jenner, CRAMS, Administrative Assistant
Submitted to:
Rural Health Education and Training Section
Health Services Division-Canberra
Compiled by:
Anne-Katrin Eckermann and Toni Dowd
on behalf of the RAN Project Teams
October 2001
National RAN Competencies The Challenge of Competence
i
Acknowledgements
A range of professional organisations, agencies and individuals have generously contributed to this project
by taking time to reflect on remote area practice and developing Significant Events, providing policy
documents, reviewing drafts of the competency standards and supporting members of the Project Team in
the field.
It would be impossible to thank all the Remote Area Nurses individually for their contributions.
Nevertheless the Project Team gratefully acknowledges the profession s support and involvement in the
development of the emerging national remote area nursing competencies which are contained in this
report.
The Royal College of Nursing, Australia has demonstrated its ongoing commitment to the project by
granting access to its professional network and supporting Di Lawson s extensive involvement in the
research throughout 1997. The Australian Human Resources Institute also contributed enormously by
supporting Di Lawson s continued involvement during 1998. Similarly the Queensland Aboriginal and
Islander Health Forum (QAIHF) has generously supported the contributions made by Mary Martin.
The Project Team would also like to acknowledge the tremendous investment and commitment of the
Council of Remote Area Nurses of Australia (CRANA) which provided the impetus for the project and the
primary mechanism for feedback to individual practitioners, employers, peak professional bodies and
other affiliated organisations. CRANA also afforded the Project Team the opportunity to participate in its
annual conferences 1997/1998 and provided continued interest, encouragement and practical support.
The Australian Nursing Federation (ANF), the Australian Nursing Council Inc. (ANCI) and the
Queensland Nursing Council (QNC) made a number of valuable reports available, distributed draft
documents to their members and contributed extensive written feedback on the draft competencies.
A number of Health Departments, such as Territory Health Services, the Western Australian Health
Department, NSW Department of Health and Queensland Health, through Chief Nursing Officers and
Regional offices supported the work of co-researchers, and the Royal Flying Doctor Service made it
possible for the team to reach a number of very isolated areas. Similarly the Victorian Bush Nurses
Association actively supported the project by providing demographic information and encouraging staff to
contribute to the project. The Tiwi Health Board (NT), Grace Fisher of the Torres and NPA Area Health
Service District, Apunipima, Cape York Health Council (Qld), Nganampa Health Council (NT),
Ngaanyatjarra Health Service (NT), East Kimberley Aboriginal Medical Service (Kununurra, WA) and
Yura Yungi Aboriginal Medical Service (Halls Creek, WA), Kimberley Aboriginal Medical Service
Council (Broome,WA) and the Sisters of Mercy (WA) generously provided access to their remote
clinics/staff and communities.
Nursing Registration Boards and Health Service Commissioners in all States responded generously to the
team s request for information about legislation based complaints against Remote Area Nurses.
Aboriginal and Torres Strait Islander Health Workers, individually or through peak bodies such as the
Aboriginal Medical Services Alliance of the Northern Territory, the Central Australian and Barkly
Aboriginal Health Workers Association and the Office of Aboriginal and Torres Strait Islander Health
provided invaluable feedback on the draft competencies as well as their potential influence on the role of
Aboriginal and Torres Strait Islander Health Workers and their communities.
Special thanks must go to the Senior Administrative Assistant in the Centre for Research in Aboriginal
and Multicultural Studies, Ms Debra Jenner, for her patience, expertise and constant support.
National RAN Competencies The Challenge of Competence
ii
National Remote Area
Nurse Competencies
This copy of the RAN Competency Standards has been produced to
complement the video ‘Remote Area Nursing: The Challenge of
Competence’. It is intended that both resources stimulate discussion and
bring to life the RAN Competency Standards at the local level.
The Centre for Research in Aboriginal
and Multicultural Studies (CRAMS)
University of New England
Armidale
Compiled by
CRAMS
University of New
England-Armidale
Endorsed by
CRANA Inc.
Copyright 2001
All rights reserved. No material may be reproduced, translated
for reproduction or otherwise utilised without the permission
from CRANA Inc. and the publisher.
Copies of this book and the video can be obtained from:
Centre for Research in Aboriginal and
Multicultural Studies (CRAMS)
University of New England
ARMIDALE NSW 2351
Phone: (02) 6773 3848
Fax:
(02) 6773 3877
Website:http://fehps.une.edu.au/f/r/edu/amc.HTML
ISBN 1 8639 771 2 National Remote Area Nurse Competencies
ISBN 1 8639 770 4 Remote Area Nursing: The Challenge of Competence
For more information on the RAN Competencies contact:
CRANA Inc
PMB 203
ALICE SPRINGS NT 0872
Phone: (08) 8953 5244
Fax:
(08) 8953 5245
Email:[email protected]
Website: www.crana.org.au
Contents
Page No.
Remote Area Nurse Competencies Project Team....................................................................
i
Acknowledgements.......................................................................................................................
ii
Preamble........................................................................................................................................
1
1.
Introduction ..........................................................................................................................
4
2.
Competency Standards for Remote Area Nurses ............................................................
6
3.
Major Paradigms which Influence Remote Area Practice .............................................
6
4.
Domain 1: Remote Area Nursing Practice .......................................................................
Overview of Domain, Units and Elements ...........................................................
Competency Unit 1.................................................................................................
Competency Element 1.1.......................................................................................
Competency Element 1.2.......................................................................................
Competency Element 1.3.......................................................................................
Competency Element 1.4.......................................................................................
Competency Element 1.5.......................................................................................
Competency Element 1.6.......................................................................................
Competency Unit 2.................................................................................................
Competency Element 2.1.......................................................................................
Competency Element 2.2.......................................................................................
Competency Unit 3.................................................................................................
Competency Element 3.1.......................................................................................
Competency Element 3.2.......................................................................................
Domain 2: Ethical and Legal Practice...............................................................................
Overview of Domain, Units and Elements ...........................................................
Competency Unit 4.................................................................................................
Competency 4.1 .....................................................................................................
Competency 4.2 .....................................................................................................
Competency Unit 5.................................................................................................
Competency Element 5.1.......................................................................................
Competency Element 5.2.......................................................................................
Competency Unit 6.................................................................................................
Competency Element 6.1.......................................................................................
Competency Element 6.2.......................................................................................
Competency Element 6.3.......................................................................................
Competency Element 6.4.......................................................................................
Competency Element 6.5.......................................................................................
10
11
12
12
13
14
14
15
15
16
16
16
17
17
17
18
19
20
20
20
21
21
21
22
22
22
23
23
23
Domain 3: Reflective Practice ............................................................................................
Overview of Domain, Units and Elements ...........................................................
Competency Unit 7.................................................................................................
Competency Element 7.1.......................................................................................
Competency Element 7.2.......................................................................................
Competency Element 7.3.......................................................................................
Competency Element 7.4.......................................................................................
Competency Element 7.5.......................................................................................
Competency Element 7.6.......................................................................................
Competency Unit 8.................................................................................................
Competency Element 8.1.......................................................................................
24
25
26
26
26
27
27
28
28
29
29
5.
6.
Competency Element 8.2.......................................................................................
Competency Unit 9.................................................................................................
Competency Element 9.1.......................................................................................
Competency Element 9.2.......................................................................................
Competency Element 9.3.......................................................................................
29
30
30
30
30
7.
Domain 4: Management and Teamwork ..........................................................................
Overview of Domain, Units and Elements......................................................................
Competency Unit 10...............................................................................................
Competency Element 10.1.....................................................................................
Competency Element 10.2.....................................................................................
Competency Element 10.3.....................................................................................
Competency Element 10.4.....................................................................................
Competency Unit 11...............................................................................................
Competency Unit 11.1 ...........................................................................................
Competency Unit 11.2 ...........................................................................................
32
33
34
34
34
35
35
36
36
36
8.
Domain 5: Communication and Negotiation....................................................................
Overview of Domain, Units and Elements ...........................................................
Competency Unit 12...............................................................................................
Competency Element 12.1.....................................................................................
Competency Element 12.2.....................................................................................
Competency Unit 13...............................................................................................
Competency Element 13.1.....................................................................................
Competency Element 13.2.....................................................................................
Competency Unit 14...............................................................................................
Competency Element 14.1.....................................................................................
Competency Element 14.2.....................................................................................
Competency Element 14.3.....................................................................................
38
39
40
40
40
41
41
41
42
42
42
42
9.
Glossary.................................................................................................................................
43
10. References ............................................................................................................................. 47
11. Individual Feedback Form .................................................................................................
49
Preamble
This edition of the Remote Area Nurse Competencies has been reproduced specifically to
accompany the video Remote Area Nursing — the Challenge of Competence. This video was
compiled to explain and complement these standards which were developed by Remote Area
Nurses (RANs) during 1998.
Rather than attempt to depict many of the individual standards — of which there are 104 — the
video explores what lies behind the obvious in the entire competency document. It raises issues to
do with the HOW of RAN practice and addresses the concepts, which lift it into the higher order
of nursing.
Generally what lies behind the obvious in this context is a high level of skill and critical
awareness tempered by sensitivity and appropriate attitudes. The latter three are sometimes
thought to be too touchy feely to describe. However, because this higher level of interaction was
thought by RANs to be integral to better practice, this competency document tackles the task of
naming and describing levels of awareness and sensitivity as well as the attitudes necessary for
effective RAN practice.
You may reasonably ask the question appropriate and effective according to whom? . Of
course the ultimate judges of this must be the consumers of the service. It is our job as RANs to
work out how best to prepare and position ourselves for the challenge of the high level of
competence demanded. Both the competency document and the video give some pointers towards
this.
The sensitivity necessary for effective RAN practice is generally shaped by —among other things
— an understanding of the power relationships operating in the society in which we are emersed,
our own position in this society and how all of this affects health care delivery. For example it is
clear to see how a nurse s position of privilege, which is seen to be at the expense of fairness to
others, would adversely affect health care delivery.
The level of awareness and sensitivity reached through this complex exercise of:
•
•
•
uncovering power relationships,
unlearning behaviours and
reshaping positions
results in a person who has (among other attributes) the attitude of continually listening across
the differences between themselves and others. They realise that there are always differences
between health professional and consumer and often there are imbalances of power. These nurses
then make this awareness work for them and their better practice. They seek to value the
differences between people and to adopt a power with rather than a power over mode of
interaction.
The people who first explored this higher order of nursing and developed practical strategies to
ensure that it remained a vital part of nursing were the Indigenous nurses of Aotearoa (New
Zealand). They named the concept, which pulls this awareness; sensitivity and attitudinal
approach together Cultural Safety and defined it as:
National RAN Competencies The Challenge of Competence
1
The effective nursing of a person/family from another culture by a nurse who
has undertaken a process of reflection on own cultural identity and recognises
the impact of the nurse s culture on own nursing practice.
(Nursing Council of New Zealand 1992)
For us in Australia, reaching this higher order in nursing means placing more emphasis on
awareness raising about ourselves and our society and implementing strategies which flow from
this more sensitive position.
Cultural Safety Competence has been defined in Australia as:
the knowledge, skills and attitudes necessary to live and work effectively
and appropriately within and between cultures, communities and professions
(attributes). Its aim is to provide high quality, safe service (performance) as
defined by those people using the service (standards).
(Dowd & Eckermann, 2001)
Cultural Safety Competence is discussed in the video and illustrated through a re-enactment of an
actual incident in a remote health centre.
The following are some examples of the level of awareness, sensitivity and action expected of
RANs and documented in their standards indeed 55% of the RAN Competencies deal with
issues related to power.
•
Knowing ourselves, our society and our particular place in it, including our privileges, the
luggage we carry and how all of this affects our nursing practice. (Competency Unit 7,
Elements 7.1 and 7.2)
•
Unmasking the hidden power relationships operating in our health care. (Competency
Unit 7, Element 7.3)
•
Raising our awareness of the politics surrounding our everyday lives and practice
(Competency Unit 1, Element 1.4 and Competency Unit 7, Element 7.5)
•
This often untouched subject relates to our understanding that when a person walks into the clinic
they bring with them the politics of their relationships and they walk into a context that is
structured by politics, there is no such thing as a neutral stance on either side. Cultural Safety
keeps this awareness before us, it:
Assumes that each health care relationship between a professional and a
consumer is unique, power laden and culturally dyadic. From this perspective,
whenever two people meet in health care interactions it inevitably involves the
convergence of two cultures. This bicultural component not only involves
unequal power and different statuses but it also often involves two cultures
with differing colonial histories, ethnicities or levels of material advantage.
(Kearns & Dyck 1996:28)
National RAN Competencies The Challenge of Competence
2
Once we have acknowledged that there is an imbalance of power and how it is affecting our
practice then we are in a position to reduce the power differential:
It is about setting up systems which enable the less powerful to genuinely
monitor the attitudes and service of the powerful, to comment with safety and
ultimately to create useful and positive change which can only be of benefit to
nursing and to all the people we serve.
(Ramsden 1993:13)
These systems will include:
•
Respect for other realities — listening across the difference. (Competency Unit 7, Element
7.4 especially cues d and f and Competency Unit 1, Element 1.1 cue e)
•
Adopting a power with mode of interaction (33 cues describe ways of doing this, some are
concentrated in Competency Units 10 and 14)
The competencies and the video give more very practical examples of this HOW of RAN
practice: •
•
•
Sharing of knowledge (Competency Unit 12, Element 12.2 and Competency Unit 4,
Element 4.2 cues a and b)
Consciously leaving responsibility where it belongs (Competency Unit 3, Element 3.2,
cues b and c and Competency Unit 5, Element 5.2 cue b and Competency Unit 7, Element
7.3 cue e)
•
No blaming of the victim (Competency Unit 2, Element 2.2 cue c, Competency Unit 6,
Element 6.5 cue c, Competency Unit 7, Element 7.3 cue c)
•
Ensuring that recipients assess the health service (Competency Unit 1, Element 1.6 cue a,
Competency Unit 7, Element 7.3 cue b and Competency Unit 14, Element 14.2 cue c)
It is clear from this cursory glance at the RAN Competencies that examples of Cultural Safety are
threaded throughout the document. May both these tools (the Competencies Document and the
accompanying video) assist health professionals to raise their awareness, sensitivity and level of
valuing difference so that they will be in a position to deliver the highest level of health care
possible to those in remote areas of Australia.
Sally Johnson AM
National RAN Competencies The Challenge of Competence
3
1. Introduction
In 1997 the Federal Government, through the Department of Health and Family Services, called
for tenders to develop national competency standards for Remote Area Nurses (RANs). The
tender was won by a team of researchers/nurse practitioners with experience in remote area
practice, brought together under the umbrella of the Centre for Research in Aboriginal and
Multicultural Studies, University of New England. The team included Associate Professor AnneKatrin Eckermann, Dr Toni Dowd, Ms Sally Johnson AM, Ms Di Lawson and Ms Mary Martin.
The research team was assisted by a number of RAN co-researchers and a Program Management
Committee.
The brief from the Department of Health and Family Services was very specific:
• To consult widely with Remote Area Nurses, remote community health authorities and
consumers about Remote Area Nursing practice;
• To review relevant literature concerning Remote Area Nursing practice;
• To consult relevant competency standards in order to assist in developing the Remote Area
Nurse Competency framework;
• To test the validity of emerging competency standards in order to assist curricula and
accreditation processes; and
• To develop and draft a set of competencies standards for Remote Area Nurses that can become
nationally recognised.
The move towards national competencies reflected over a decade of lobbying by the Council of
Remote Area Nurses of Australia Incorporated (CRANA) supported by numerous discussion
papers/reports and publications (eg Cramer 1987, 1991, 1993, 1995; Cameron-Traub 1987;
CRANA 1991, 1992, 1993, 1995; Keane 1993, 1994) and emerging pressures in the health
professions, including nursing, for national recognition and accreditation of the skills, knowledge
and attitudes required for current practice (see for example the Australian Nursing Council
Incorporated (ANCI) 1994, 1998; Australian Nurse Teacher’s Society 1994; Australian New
Zealand College of Mental Health Nurses Inc. 1995; Confederation of Australian Critical Care
Nurses (CACCN) 1996; the Australian Nursing Federation (ANF) 1997 and the NSW Health
Department (1998), Nurse Practitioner Services report).
A number of writers and reports (eg Munoz and Mann 1982; Klotz 1983; Cramer 1984, 1988,
1989, 1992, 1993; Blackman 1985; Kreger 1991; Buckley and Gray 1991, 1993; Australian Health
Minister s Advisory Committee ( AHMAC) 1993; Johnson 1992, 1993; Knight 1992; O Farrell
1993; Potts 1990; Dowd and Johnson 1995; Fisher et al 1995) have argued that the role of
Remote Area Nurses differs significantly from that of other registered nurses because it is
intrinsically linked to primary health care in settings and situations which are frequently
professionally, socially, geographically and culturally isolated. As such the Remote Area Nurse
must possess the attributes of an advanced practitioner as outlined by ANF (1997) as well as
those which are specific to remote area practice.
National RAN Competencies The Challenge of Competence
4
In line with the Commonwealth s brief this report includes:
•
•
•
•
•
•
A review of the major paradigms which influence remote area practice;
a detailed outline of the RAN Competency Standards;
an account of the research process on which these competencies are based;
an explanation of the data analysis and process of validation;
a detailed glossary and list of references; and
a series of Appendices which include eight significant events to illustrate the process of data
analysis utilising Ethnograph 4 which led to the competencies, as well as the data collection
tools, examples of feedback to the profession.
The final set of RAN Competencies have been informed by a number of sources and resources.
These include the data collected by and from Remote Area Nurses, relevant literature and the
competencies developed for a range of other groups including professional, industrial nursing and
regulatory authorities such as: the Competency Standards for the Advanced Nurse 1997, the
Australian Nursing Council Incorporated (ANCI) 1998, the Aboriginal Health Worker and Torres
Strait Islander Health Worker National Competencies (1996), the Confederation of Australian
Critical Care Nurses Inc (1996), the Royal Flying Doctor Service (RFDS) Flight Nurses (1997),
the NSW Department of Health (1998), Nurse Practitioner Services report and the Nursing
Council of New Zealand (1996).
The RAN Competencies which have been developed in this document are not a check list of
skills; or a series of specific performance indicators. This was not the team s brief. Although
these Competencies, may overlap with those expected of any competent practitioner, they are
constantly grounded in the complexity and variety of the remote area context. As such they will
provide opportunity for the development of accreditation criteria and performance indicators
appropriate to the many roles performed by Remote Area Nurses. No doubt such developments
will shape and inform curriculum development designed to enhance remote area practice.
National RAN Competencies The Challenge of Competence
5
2. Competency Standards for Remote Area Nurses
The following competencies reflect the diverse range of abilities including, skills, knowledge and
attitudes which are required to implement comprehensive nursing care in remote area settings.
These competencies are organised into the following domains:
Remote Area Nursing Practice
Units 1 to 3
Ethical and Legal Practice
Units 4 to 6
Reflective Practice
Units 7 to 9
Management and Teamwork
Units 10 to 11
Communication and Negotiation
Units 12 to 14
3. Major Paradigms Which Influence Remote Area Practice
The role and scope of practice of Remote Area Nurses (RANs) was developed by the Council of
Remote Area Nurses of Australia (CRANA) which defined the RAN as follows:
The remote area nurse (RAN) is a registered nurse whose day to day practice
encompasses all or most aspects of Primary Health Care. This practice most
often occurs in an isolated or geographically remote location. The RAN is
responsible, either solely or as a member of a small team, for the continuous
coordinated and comprehensive health care in that location.
(Knight 1992)
This definition, which was accepted by the Australian Health Ministers Advisory Council in
1993, implies that the RAN:
•
•
•
•
•
•
•
•
•
•
will be able to demonstrate the core competencies that are required of all registered nurses;
will be required to practise at an advanced level in the unique context of remote area nursing
practice;
will frequently be working in isolation (geographically, socially, culturally and
professionally);
may be a sole practitioner or a member of a small team;
will be required to deliver comprehensive primary health care (PHC) related not only to
individuals and families but to whole communities
will be required to provide care across the lifespan of diverse groups;
will be required to provide health care across a diverse range of health specialties;
will be required to work in partnership and negotiate with a variety of community groups and
other health professionals;
will be required to reflect on and acknowledge the values and norms of own socio-cultural
traditions in order to appreciate those associated with others; and
will frequently be working in a cross cultural environment and will consequently be required
to adapt skills, knowledge and attitudes to local customs and traditions.
National RAN Competencies The Challenge of Competence
6
The PHC principles inherent in this definition include:
• promoting an understanding of health as a complete state of physical,
social and emotional well-being, not merely the absence of disease.
• contributing to meeting the main health needs of a defined community.
• equity and accessibility: providing services close to where people live and
work, without financial, geographic, cultural or other barriers.
• comprehensive program content that includes primary health care, health
promotion, and the management of ongoing health problems.
• the participation of people and communities in debate and decision making
about health issues and their own health care.
• promoting a multidisciplinary approach amongst health practitioners.
• efficient, effective and accountable management practices.
(CHASP 1993, np)
The emphasis on PHC within remote area nursing, highlights another distinguishing theme which
characterises this specific area of practice, that of community development. For the purpose of
this project, and in line with the emphasis on empowerment and wholistic care in PHC,
community development may be defined as:
Empowering people to participate effectively in the social, political and
cultural life and in the decision-making process ....
(Spindler 1994,4)
As such, community development is:
...based on the premise that individuals are responsible to determine the
direction of their own lives, and that people at the ’grass roots’ or local level
should be directly involved in the decision-making processes affecting their
communities.
(Aytan 1991, 8)
The implications for practice of PHC, including community development, are complicated by the
fact that some 80 per cent of RANs work in cross-cultural settings. The requirement of Remote
Area Nurses to develop abilities relating to cross-cultural communication and negotiation is
consequently a feature of their practice and is reflected in the competencies which describe the
range of activities clinical, educational, managerial and intersectoral which the majority of
RANs are required to perform.
From the above discussion it is clear that Remote Area Nurses operate as competent and/or
proficient practitioners (Benner 1984) and consequently bring to remote area practice the skills,
knowledge and attitudes of the advanced nurse (ANF 1997). Such a competent/proficient
practitioner will be able to begin to accommodate the specialised demands of the remote area
context due to past experience and the ability to perceive the challenges of practice wholistically
(Benner 1984).
National RAN Competencies The Challenge of Competence
7
This report follows the definition of competency established by Gonczi, Nager and Olyver (1990)
and endorsed by the NNO Glossary of Terms Sub-Committee (1998) where:
.... Attributes such as knowledge, skills, attitudes and abilities, in combination
underlie competence....
(NNO 1998, 3)
Within this context, competence is a combination of attributes in a particular context (Lawson
1998). The capability to perform competently is a product of experiences and knowledge
acquisition. Competent performance in the remote area context should then be viewed as a
kaleidoscope of possible combinations and variations complicated by multiple entry points into
practice, the range of contexts in which practice occurs and the variety of inductions, orientations
and professional development programs available to Remote Area Nurses to improve their
practice.
There are 14 competency units clustered into five domains. The units contain a range of elements
of competence and a series of cues which provide examples of standards of practice in the remote
context. The cues are neither an exhaustive list nor a checklist of performance criteria but seek to
capture the best examples of standards of practice.
Within this practice, Remote Area Nurses will perform at varying levels of sophistication
depending on the type and extent of orientation provided by employers, their experience and
professional development. Indeed, practitioners have identified this as a continuum of
competence in which new RANs will increase their repertoire of skills with new knowledge,
experience and professional development.
The levels of sophistication at which RANs will perform these competencies are summarised in
the following diagram as are the pathways by which they may be acquired.
National RAN Competencies The Challenge of Competence
8
Experiential Pathways
Orientation(s)
Professional
Development in
specific areas of
specialisation eg
Audiometry
Counselling
Critical Care
Diabetes
Early Childhood
Emergency Care
Gerontology
Mental Health
Midwifery
Palliative Care
Education Pathways
Experienced
RAN Practice
Master of Remote
Health Practice
Experienced
RAN
RAN Practice
Graduate Diploma
in Remote Health
Practice
Graduate Certificate
in Health (Remote
Health Practice)
Advanced Nurse
Practice
eg Generalist,
Midwifery, Critical Care
Beginning Registered
Nurse Practice
Core Competence
ANCI
Diagram 1:Pathways to Specialisation in RAN Practice
National RAN Competencies The Challenge of Competence
9
Domain 1: Remote Area Nursing Practice
Remote Area Nursing Practice: these competencies describe the abilities of RANs to
provide high quality health care in situations of geographical, social, cultural and professional
isolation; while at the same time, caring for self and other team members. Competencies in this
domain reflect skills, knowledge and attitudes related to safe and effective PHC which includes
the management of emergency situations, public health programs, advanced clinical skills and
awareness of the political context in which health care is provided, as well as effective self
care. Importantly, this domain includes community development competencies which are
directly related to the context of remote community based practice. They include the
necessity to understand the community in which remote area nursing practice occurs and the
need to form partnerships with that community to implement effective PHC.
National RAN Competencies The Challenge of Competence
10
Domain: Remote Area Nursing Practice
Competency Unit 1
Provides safe, high quality health care across the
lifespan of individuals/communities in remote areas
Competency Element 1.1
Makes clinical decisions and complex professional
judgements in isolation from other health professionals
Competency Element 1.2
Balances the demands of clinical treatment with the need for
preventive health activities within the parameters of the
service
Competency Element 1.3
Manages a range of emergency situations
Competency Element 1.4
Applies knowledge of organisations, communities and
different levels of government to improve health care
Competency Element 1.5
Provides health care across the lifespan to individuals and
families within their own communities
Competency Element 1.6
Monitors and evaluates the quality of health care
Competency Unit 2
Demonstrates commitment to self care and safe practice
in the remote workplace
Competency Element 2.1
Implements strategies to maintain wellbeing
Competency Element 2.2
Maintains safe practice while dealing with the rigour of
remote living
Competency Unit 3
Adopts a community development approach to health
care
Competency Element 3.1
Demonstrates awareness of the nature of the community
Competency Element 3.2
Fosters the partnership between the local community and the
health care team
National RAN Competencies The Challenge of Competence
11
Domain: Remote Area Nursing Practice
Competency Unit 1
Provides safe, high quality health care across the lifespan of
individuals/communities in remote areas
Competency Element 1.1 Makes clinical decisions and complex professional
judgements in isolation from other health professionals
Cues
a.
Demonstrates a range of advanced clinical skills
b.
Uses standard treatment protocols to guide practice
c.
Undertakes accurate and prompt assessment independently
or in collaboration with relevant members of the team
d.
Establishes a system of checking that actions can be justified
(eg diagnosis, drugs, dosage) in the absence of other health
professionals
e.
Utilises local community knowledge, including Health
Worker/family knowledge, about clients to achieve optimum
health care whilst maintaining confidentiality and cultural
safety
f.
Supports collaborative problem solving and clinical decision
making
g. Employs multiple skills to achieve the best health outcomes
h. Makes appropriate referrals when necessary
i. Responds to requests for help even when little information is
available
National RAN Competencies The Challenge of Competence
12
Domain: Remote Area Nursing Practice
Competency Element 1.2 Balances the demands of clinical treatment with the need
for preventive health activities within the parameters of the
service
Cues
a.
Identifies elements necessary for
comprehensive health care in remote areas
wholistic
and
b. Demonstrates the capacity to move confidently between the
various elements of health care
c. Consistently applies the principles of primary health care
d. Develops strategies to address public health issues in a
collaborative manner
e. Takes the requirements and concerns of stakeholders into
account when planning health care
f. Identifies interventions which do not contribute to the health
advancement of individuals and communities
g. Informs the employer about community
requirements to provide effective health care
National RAN Competencies The Challenge of Competence
and
team
13
Domain: Remote Area Nursing Practice
Competency Element 1.3 Manages a range of emergency situations
Cues
a.
Identifies and uses available resources and improvises where
necessary to achieve the best outcome
b.
Uses previous experience and all data available to make
decisions in complex situations
c.
Initiates a triage response promptly
d.
Uses professional judgement and established protocols to
make the decision about whether to evacuate/transport a
person or not
e.
Manages a range
simultaneously
f.
Develops strategies to deal with sequential critical incidents
g.
Provides clear explanations and directions to those assisting
in an emergency
h.
Maintains a professional focus and an effective process of
care even when dealing with own emotions
i.
Contributes to the development and maintenance of disaster
plans
of
emergencies
that
may
arise
Competency Element 1.4 Applies knowledge of organisations, communities and
different levels of government to improve health care
Cues
a.
Demonstrates an awareness of the influence of employer
and other organisations values on health care
b.
Uses political astuteness to improve service access and
health outcomes
_
c. Provides accurate information to management and the broader
community about the realities of remote health and practice
issues
National RAN Competencies The Challenge of Competence
14
Domain: Remote Area Nursing Practice
Competency Element 1.5 Provides health care across the lifespan to individuals and
families within their own communities
Cues
a.
Identifies and supplements knowledge necessary to provide
optimal wholistic care across the lifespan
b. Implements
strategies
in
collaboration
with
colleagues/community to address the diverse and complex
physical, social and emotional needs of a total community
c. Uses comprehensive assessments skills in caring for
individuals in different stages of the life cycle
Competency Element 1.6 Monitors and evaluates the quality of health care
Cues
a.
Develops strategies to ensure community feedback and
utilises this to adapt and optimise practice
b. Allocates time to planning and evaluation of practice
c. Develops tools to monitor and evaluate health care
provisions and outcomes
d. Accesses support available from employer bodies and/or
communities to facilitate planning and evaluation of practice
e. Actively participates in performance review processes
f. Encourages sharing of effective practice
National RAN Competencies The Challenge of Competence
15
Domain: Remote Area Nursing Practice
Competency Unit 2
Demonstrates commitment to self care and safe practice in the
remote workplace
Competency Element 2.1 Implements strategies to maintain wellbeing
Cues
a.
Accepts responsibility for maintaining own wellbeing
b.
Identifies employers duty of care to employees
c.
Identifies strategies to maintain wellbeing in situations of
cultural, geographic, professional, and social isolation,
implements these and monitors the outcomes
d.
Identifies personal, community and regional resources which
can contribute to maintenance of wellbeing
e.
Identifies personal support needs and seeks support from
appropriate persons when necessary, particularly following
stressful incidents
f.
Sets realistic goals and expectations of self and role in the
context of a particular community
Competency Element 2.2 Maintains safe practice while dealing with the rigour of
remote living
Cues
a.
Identifies the impact of geographic isolation on access to
health resources and on nursing practice
b.
Demonstrates an understanding of own
vulnerability and its potential to affect practice
c.
Identifies when social dysfunction is present in
communities/families and the challenges this presents for
practice
emotional
d. Demonstrates safe practices for travelling in remote areas
e.
Demonstrates skills with remote area communication
technology
National RAN Competencies The Challenge of Competence
16
Domain: Remote Area Nursing Practice
Competency Unit 3
Adopts a community development approach to health care
Competency Element 3.1 Demonstrates awareness of the nature of the community
Cues
a.
Identifies and makes contact with key decision makers and
resource people within the community in order to enhance
practice
b.
Demonstrates the ability to gain the confidence and trust of
the community
c.
Adjusts practice to suit the reality of community life within
the parameters of mutual respect and accountability
d.
Supports and reviews community profiles in partnership
with the community
Competency Element 3.2 Fosters the partnership between the local community and
the health care team
Cues
a.
Fosters an egalitarian environment between members of the
health team and the community
b.
Encourages team members and the community to arrive at
solutions to identified problems
c.
Involves community leaders in negotiations about safety
matters related to the community
d.
Negotiates and prioritises the parameters of team activities
in collaboration with the wider community/organisation
National RAN Competencies The Challenge of Competence
17
Domain 2: Ethical and Legal Practice
Ethical and Legal Practice: these competencies reflect the legal and ethical responsibilities
of remote area nursing practice. They describe the abilities of RANs in community based
practice, to advocate for the community as well as individual/family rights, to negotiate care
and to demonstrate empathy and respect for cultural differences.
National RAN Competencies The Challenge of Competence
18
Domain 2: Ethical and Legal Practice
Competency Unit 4
Advocates and protects the rights of individuals, families
and communities in relation to health care
Competency Element 4.1
Advocates the rights of individuals/families and communities
Competency Element 4.2
Provides opportunities for the individual/group to actively
participate in the process of care
Competency Unit 5
Conducts remote area nursing practice in a way that can
be ethically justified
Competency Element 5.1
Bases nursing action on ethical decision making
Competency Element 5.2
Maintains confidentiality of information within the confines
of living and working in an isolated community
Competency Unit 6
Functions in accordance with legislation, taking account
of customary law and common law affecting remote area
nursing practice
Competency Element 6.1
Works within legal requirements, policies and procedures
governing remote area nursing practice
Competency Element 6.2
Relates legislative and common law concepts to policies and
procedural guidelines for remote area nursing practice
Competency Element 6.3
Promotes the protection and safety of self and others and
intervenes as appropriate
Competency Element 6.4
Demonstrates awareness of the influence of customary law
on community life
Competency Element 6.5
Acts as a change agent to improve health outcomes
National RAN Competencies The Challenge of Competence
19
Domain: Ethical and Legal Practice
Competency Unit 4 Advocates and protects the rights of individuals, families and
communities in relation to health care
Competency Element 4.1 Advocates the
communities
Cues
rights
of
individuals/families
and
a.
Identifies and respects the common, cultural and legal rights
of individuals/groups in relation to the health care system
b.
Identifies and adheres to strategies for the promotion and
protection of individuals/groups rights
c.
Consults with appropriate family/community and advocates
when an individual cannot act for him/herself
Serves as an advocate even when the rights of
individuals/groups are overlooked and/or compromised
d.
e.
Assumes an advocacy role when necessary to address health
access and equity issues
Competency Element 4.2 Provides opportunities for the individual/group to actively
participate in the process of care
Cues
a.
Develops strategies for engaging individuals/families and
communities in the consultative process
b.
Informs individuals/groups about the available options, in
terms that are understandable, at all stages of the care
process
c.
Facilitates
and
encourages
independence
of
individuals/groups by providing an environment for
informed choice
d.
Adopts an interaction style which promotes active
participation
National RAN Competencies The Challenge of Competence
20
Domain: Ethical and Legal Practice
Competency Unit 5
Conducts remote area nursing practice in a way that can be
ethically justified
Competency Element 5.1 Bases nursing action on ethical decision making
Cues
a.
Identifies potential sources of particular ethical and moral
challenges related to the remote context
b.
Demonstrates respect for matters identified by Health
Workers as having ethical implications for them (even when
these are not fully understood)
c.
Conducts assessments in ways which are sensitive to the
individual/groups needs and cultural norms
d.
Creates opportunities for discussion and resolution of moral
conflicts
Competency Element 5.2 Maintains confidentiality of information within the
confines of living and working in an isolated community
Cues
a.
Identifies the issues of confidentiality presented by living
and working in the community
b.
Promotes the development, with the community, of
protocols for confidentiality which are in accordance with
professional and community norms
c. Develops strategies with the health care team and community
to deal with breaches of confidentiality
National RAN Competencies The Challenge of Competence
21
Domain: Ethical and Legal Practice
Competency Unit 6
Functions in accordance with legislation, taking account of
customary law and common law affecting remote area nursing
practice
Competency Element 6.1 Works within legal requirements, policies and procedures
governing remote area nursing practice
Cues
a.
Identifies legislation which impacts on scope of practice in
remote communities
b.
Maintains records in accordance with relevant current
legislation, including drug storage, administration and
dispensing
c.
Complies with occupational health and safety legislation
relevant to location and context of practice
d.
Alerts authorities to any dissonance between practice needs
and legislative frameworks
Competency Element 6.2 Relates legislative and common law concepts to policies and
procedural guidelines for remote area nursing practice
Cues
a.
Complies with the State/Territory and local Health Service
policy requirements governing the storage, handling,
administration and dispensing of medication where enabled
to do so by the employing authority
b.
Alerts employing authority to any dissonance between
policy requirements and service provision
c.
Identifies organisational and community policies, protocols
and guidelines which impact on remote practice and works
within these
d.
Identifies and explains legal implications of policies and
procedural guidelines
e.
Maintains documentation which
community and agency requirement
f.
Identifies differences between legislation and local policies
and principles
and refers these
to
relevant
agencies/organisations
g.
Accurately records processes of decision making to
demonstrate accountability for nursing actions, outcomes
and ongoing care
National RAN Competencies The Challenge of Competence
conforms
to
legal,
22
Domain: Ethical and Legal Practice
Competency Element 6.3 Promotes the protection and safety of self and others and
intervenes as appropriate
Cues
a.
Promotes environmental health and safety protocols in the
community
b.
Demonstrates the skills to undertake a risk needs
assessment
c.
Identifies breaches of occupational health and safety
standards and initiates action to address the situation
d.
Implements strategies to reduce the potential for unsafe
practice
e.
Challenges inappropriate
alternatives
interventions
and
proposes
f. Implements a plan of remedial action, in consultation with
colleagues and community representatives, when unsafe
practices persist
g. Asserts the integrity of own professional practice in relation
to other professional groups
Competency Element 6.4 Demonstrates awareness of the influence of customary law
on community life
Cues
a.
Demonstrates an understanding of the fact that many
Indigenous peoples live by more than one law
b.
Seeks guidance from Health Workers and/or other
community members in relation to the influence of
customary law on practice
c. Demonstrates respect for Indigenous law
Competency Element 6.5 Acts as a change agent to improve health outcomes
Cues
a.
Acts to bring about change to policy/procedural guidelines if
rights are compromised or the best outcome is not being
achieved
b. Persists in seeking access to appropriate services even when
access is difficult or denied
c. Acknowledges the impact of socio-economic circumstances
on health behaviour and acts to minimise the stress created
by this
National RAN Competencies The Challenge of Competence
23
Domain 3: Reflective Practice
Reflective Practice: these competencies are related to abilities required of RANs to practise in a
range of settings including those which are cross cultural. They require in-depth self knowledge,
awareness of differing perceptions of health and community based health resources, respect for
cultural differences and development of strategies for creating culturally safe environments for
clients, colleagues and self. Additionally the competencies in this domain require RANs to reflect on
self and others professional development needs. Such reflection includes how they learn in the
workplace as well as their commitment to contributing to nursing and PHC research processes.
National RAN Competencies The Challenge of Competence
24
Domain 3: Reflective Practice
Competency Unit 7
Identifies own values and beliefs and their impact within the
remote area setting on self, own practice and community
Competency Element 7.1
Addresses the impact of own culture on health care
Competency Element 7.2
Questions the professional biases, values and assumptions that
guide practice
Competency Element 7.3
Addresses the impact of power relations on remote health care
Competency Element 7.4
Implements strategies for providing a culturally safe environment
Competency Element 7.5
Demonstrates an understanding of the impact of the values,
customs and spiritual beliefs of individuals/groups on own practice
Competency Element 7.6
Addresses the impact of culture shock on remote health practice
Competency Unit 8
Engages in collaborative approaches to professional learning
and development
Competency Element 8.1
Identifies own professional development needs
Competency Element 8.2
Enhances the professional development of others
Competency Unit 9
Utilises research to inform own practice and to improve
standards of care
Competency Element 9.1
Promotes research and evaluation which is collaborative and
provides feedback
Competency Element 9.2
Contributes to the process of nursing and primary health care
research
Competency Element 9.3
Uses the paradigms of nursing and primary health care research to
inform practice
National RAN Competencies The Challenge of Competence
25
Domain: Reflective Practice
Competency Unit 7
Identifies own values and beliefs and their impact within the remote
area context on self, own practice and the community
Competency Element 7.1 Addresses the impact of own culture on health care
Cues
a.
Articulates the impact of personal values and beliefs on own
actions, interactions and reactions
b.
Describes own preferred motivational, learning and communication
styles
c.
Articulates own concept of health and health beliefs and identifies
impact on own practice
d.
Consults with Health Workers or significant people when the
situation is judged beyond own scope of understanding
Competency Element 7.2 Questions the professional biases, values and assumptions that
guide practice
Cues
a.
Identifies own professional values, beliefs and assumptions that
underpin practice
b.
Evaluates own practice and its effect on interaction with the
community
c.
Describes the implications for practice when separate knowledge
systems are operating
National RAN Competencies The Challenge of Competence
26
Domain: Reflective Practice
b.
Competency Element 7.3 Addresses the impact of power relations on remote health care
Cues
a.
Articulates the importance of self determination on the part of the
community and individuals
b.
Facilitates consumer assessment of the health service
c.
Demonstrates an understanding of the processes underlying
powerlessness, whether applied to self or others
d.
Devises strategies to address the power imbalance between
professionals and others in the broader community
e.
Relinquishes authority when it
responsibility should lie elsewhere
Competency Element 7.4 Implements strategies
environment
Cues
for
becomes clear that
providing
a
culturally
the
safe
a.
Understands the adaptation process necessary to become effective
practitioners in a particular remote community
b.
Incorporates knowledge of cross cultural and historical factors into
practice
c.
Consults and learns about the role of the family in health care and
decision making in order to guide planned intervention
d.
Identifies and clarifies people s health beliefs and practices
e.
Consults and collaborates with relevant people to provide reliable
and culturally safe information to guide individual and family
decision making
f.
Respects differences in cultural meanings and responses to health
and illness and demonstrates this in practice
g.
Demonstrates an understanding of the responsibilities
acceptance by another culture
National RAN Competencies The Challenge of Competence
of
27
Domain: Reflective Practice
Competency Element 7.5 Demonstrates an understanding of the impact of the values,
customs and spiritual beliefs of individuals/groups on own
practice
Cues
a.
Takes into account the individuality, rights and socio/cultural
traditions of the individual/group when providing care
b.
Identifies and responds appropriately to individual/community
reactions to situations
c.
Adapts activities to suit the way the community functions
d.
Identifies in consultation with significant people resources which
are culturally/emotionally/spiritually safe
Competency Element 7.6 Addresses the impact of culture shock on remote health practice
Cues
a.
Identifies the signs and symptoms of culture shock in self and
others
b.
Identifies the major stressors that contribute to culture shock
c.
Seeks strategies for managing culture shock
d.
Accesses appropriate community and professional support
networks
e.
Reflects on culture shock and its impact on professional practice
National RAN Competencies The Challenge of Competence
28
Domain: Reflective Practice
Competency Unit 8
Engages in collaborative approaches to professional learning and
development
Competency Element 8.1 Identifies own professional development needs
Cues
a.
Identifies own professional limitations and abilities
b. Articulates experiences which have led to
professional activities
adaptation
of
c. Seeks opportunities to maintain/update skills
Competency Element 8.2 Enhances the professional development of others
Cues
a.
Demonstrates role modelling to other members of the health care
team
b.
Utilises coaching and mentoring techniques to assist and develop
colleagues as required
c.
Supports health care students to meet their learning objectives in
co-operation with other members of the health care team
d.
Contributes to orientation and ongoing education programs
National RAN Competencies The Challenge of Competence
29
Domain: Reflective Practice
Competency Unit 9
Utilises research to inform own practice and to improve standards of
care
Competency Element 9.1 Promotes research and evaluation which is collaborative and
provides feedback
Cues
a.
Facilitates provision of accurate information about outside
requests for research to the local health team and relevant
community members
b.
Creates opportunities for interested Health Workers and
community members to take part in all stages of the research
process
c.
Provides opportunity for groups to gain skills in research decision
making
d. Respects different patterns and processes of inquiry and decision
making
e. Supports processes that provide useful and timely feedback to
stakeholders
Competency Element 9.2 Contributes to the process of nursing and primary health care
research
Cues
a.
Identifies research problems and priorities in collaboration with
colleagues and the community
b.
Supports community and professional research initiatives
c.
Creates and/or accesses opportunities to facilitate remote area
nursing and primary health care research in consultation with
colleagues and the community
d.
Negotiates the use of research findings with relevant stakeholders
National RAN Competencies The Challenge of Competence
30
Domain: Reflective Practice
Competency Element 9.3 Uses the paradigms of nursing and primary health care research
to inform practice
Cues
a.
Articulates the influence of nursing and primary health care
research on own practice
b.
Incorporates research findings into own practice
c.
Evaluates own practice in terms of research findings to ensure best
outcomes
National RAN Competencies The Challenge of Competence
31
Domain 4: Management and Teamwork
Management and Teamwork: these competencies include the wide range of
management/teamwork skills required of remote area nursing practice. They encompass the
application of models for negotiation of shared management, developing collaborative working
relationships with other health professionals, resource management in remote environments,
development and support of health teams and mutual recognition and sharing of skills in
partnership situations which are frequently but not exclusively cross cultural in nature.
National RAN Competencies The Challenge of Competence
32
Domain: Management and Teamwork
Competency Unit 10
Develops effective management strategies to implement
and support primary health care
Competency Element 10.1
Negotiates for shared management
Competency Element 10.2
Acts as a resource person to the team
Competency Element 10.3
Fosters an environment in which people can empower
themselves
Competency Element 10.4
Provides and manages resources effectively and efficiently
Competency Unit 11
Facilitates teamwork
Competency Element 11.1
Fosters partnerships within the multi-disciplinary health care
team
Competency Element 11.2
Establishes and maintains effective and collaborative working
relationships with other members of the health care team,
including the broader community
National RAN Competencies The Challenge of Competence
33
Domain: Management and Teamwork
Competency Unit 10 Develops effective management strategies to implement and
support primary health care
Competency Element 10.1 Negotiates for shared management
Cues
a.
Facilitates the initial negotiation of roles and functions for
new team members and ensures that these are fully
understood by all
b. Identifies community and employer expectations of own role
and negotiates role where appropriate
c. Facilitates the regular review and renegotiation of all roles and
responsibilities within the team as the need arises
d. Delegates and accepts responsibilities to facilitate optimum
care
e. Facilitates decision making
collaboration
within
a
framework
of
f. Develops strategies to cope with accountability stress in
consultation with others
g. Assumes leadership, coordination and/or management roles
when appropriate within the team
Competency Element 10.2 Acts as a resource person to the team
Cues
a.
Supervises team activities to develop team members skills
and responsibilities as required
b.
Identifies the potential for emotional and physical trauma
for co-workers and community members in crisis situations
and provides appropriate support
c.
Demonstrates the ability to support and guide isolated team
members
d.
Accesses opportunities to develop own team facilitation
skills
National RAN Competencies The Challenge of Competence
34
Domain: Management and Teamwork
Competency Element 10.3 Fosters an environment in which people can empower
themselves
Cues
a.
Supports the development of team members self identified
learning needs
b.
Transfers skills to other members of the team appropriately
c.
Provides open and honest feedback in a sensitive manner to
team members and is able to receive same
d.
Facilitates team review and evaluation processes in a way
that encourages team development
Competency Element 10.4 Provides and manages resources effectively and efficiently
Cues
a.
Facilitates the development of policies regarding use of
material and human resource in consultation with the
community
b.
Applies a problem solving approach to the management of
resources
c.
Conducts routine inventory and stock checks on supplies
and equipment
d.
Demonstrates familiarity with local equipment use and
maintenance in remote areas
e.
Maintains emergency equipment
f.
Demonstrates ability to improvise safely when resources
are limited or not available
g.
Develops and/or seeks resources to assist practice
National RAN Competencies The Challenge of Competence
35
Domain: Management and Teamwork
Competency Unit 11 Facilitates teamwork
Competency Element 11.1 Fosters partnerships within the multi-disciplinary health
care team
Cues
a.
Negotiates the parameters of the partnership with other
health care workers
b.
Identifies criteria to monitor the partnership in collaboration
with other health care workers
c.
Identifies factors that facilitate or hinder partnerships
within the team
Competency Element 11.2 Establishes and maintains effective and collaborative
working relationships with other members of the health
care team, including the broader community
Cues
a.
Invites feedback from other members of the team on own
nursing practice
b.
Maintains a two way learning process with other members
of the team
c.
Identifies and utilises the cultural broker and safety role of
Health Workers when they are part of the team
d.
Identifies the social pressures within the community that
may be impacting on Health Workers when they are part of
the team and reflects this in team organisation
National RAN Competencies The Challenge of Competence
36
National RAN Competencies The Challenge of Competence
37
Domain 5: Communication and Negotiation
Communication and Negotiation: these competencies reflect the diverse and complex levels of
communication and negotiation which are the backbone of remote area nursing practice. They
identify RAN capabilities associated with cross cultural communication, developing communication
networks, dealing effectively with conflict and negotiating strategies for community participation in
health care programs. Further the nature of RAN practice demands sound processes for information
sharing and negotiation beyond the community in order to provide safe, appropriate health care.
Integral to this form of negotiation is a focus on understanding meanings, and negotiating and coordinating differing and shared interests towards achieving shared goals of [individual/family and
community] care (Keatinge 1998, 39). Implicit in this group of competencies are the attributes
necessary to demonstrate respect and to generate trust in order to establish the relationships
necessary for effective community based health care.
National RAN Competencies The Challenge of Competence
38
Domain: Communication and Negotiation
Competency Unit 12
Demonstrates advanced skills in communication
Competency Element 12.1
Demonstrates an understanding of cross cultural interaction
Competency Element 12.2
Provides relevant and timely health information to individuals and
groups in a form which facilitates their understanding
Competency Unit 13
Deals effectively with conflict in the remote workplace
Competency Element 13.1
Demonstrates ability to identify and respond to situations which
have the potential for conflict
Competency element 13.2
Facilitates conflict resolution
Competency Unit 14
Demonstrates effective negotiation and liaison skills
Competency Element 14.1
Encourages and supports individuals/groups in decision making
Competency Element 14.2
Negotiates health care plans which reflect community priorities
Competency Element 14.3
Demonstrates intersectoral collaboration
National RAN Competencies The Challenge of Competence
39
Domain: Communication and Negotiation
Competency Unit 12 Demonstrates advanced skills in communication
Competency Element 12.1 Demonstrates an understanding of cross cultural interaction
Cues
a.
Demonstrates an understanding of the complexity of cross
language communication and the principles underlying cross
cultural interaction
b.
Identifies own preferred style of communication
c.
Demonstrates effective cross cultural communication skills
d.
Adapts communication to reflect individual s preferred style of
interaction, including, when necessary, the local language
Competency Element12.2 Provides relevant and timely health information to individuals
and groups in a form which facilitates their understanding
Cues
a.
Assesses people s level of understanding of their health and health
care options
b.
Supports team members to provide relevant and timely health care
information to their community
c.
Identifies culturally safe information sharing strategies in
collaboration with individuals and communities
National RAN Competencies The Challenge of Competence
40
Domain: Communication and Negotiation
Competency Unit 13 Deals effectively with conflict in the remote workplace
Competency Element 13.1 Demonstrates ability to identify and respond to situations which
have the potential for conflict
Cues
a.
Identifies situations which have the potential to generate conflict
b.
Develops and implements strategies to prevent or minimise risk
and monitors outcomes
Competency element 13.2 Facilitates conflict resolution
Cues
a.
Identifies the influence of own past experiences on the way
conflict is handled
b.
Applies a range of conflict resolution/negotiation skills to
manage/resolve issues/incidents
c.
Seeks/accepts assistance when situations are beyond own skills
d.
Seeks debriefing from employer/colleagues as necessary
e.
Adheres to organisational and/or community guidelines when
responding to conflict
National RAN Competencies The Challenge of Competence
41
Domain: Communication and Negotiation
Competency Unit 14 Demonstrates effective negotiation and liaison skills
Competency Element 14.1 Encourages and supports individuals/groups in decision making
Cues
a.
Evaluates own patterns of decision making and their impact on
health care delivery
b.
Articulates cultural norms determining processes of decision
making in the community
c.
Facilitates and encourages individual/group s decision making
processes in relation to health
d. Develops strategies for effective information sharing with the
community
Competency Element 14.2 Negotiates health care plans which reflect community priorities
Cues
a.
Supports the community to identify health needs
b.
Facilitates community participation
implementation of health initiatives
c.
Collaborates with the community to develop appropriate program
monitoring and evaluation strategies
d.
Negotiates realistic objectives and time frames for health team
activities
in
planning
and
Competency Element 14.3 Demonstrates intersectoral collaboration
Cues
a.
Identifies
and
provides
information
about
agencies/resources outside the local community
b.
Collaborates with outside agencies/organisations and forms
strategic alliances wherever this is appropriate to enhance the
continuity and delivery of care
National RAN Competencies The Challenge of Competence
relevant
42
Glossary
Accountability stress
Refers to the difficulties associated with divided or conflicting
accountability eg. there may be stress associated with a RAN s
accountability to employer which may conflict with the
expectations of the community.
Collaboration
Involves working together as colleagues to enhance the achievement
of common aims.
Community
The term community is used to describe people who share a sense of
identity or have common concerns. Communities are not always
neighbourhood or locally based No matter how small in area or
in population a community is made up of many subcommunities (Auer, Repin & Roe 1993, 165)
Competence, competency,
competent standard
A competent professional can be defined as a person who has the
attributes necessary for job performance to the appropriate
standard. This definition focuses on three elements: attributes,
performance and standards. Attributes such as knowledge, skills,
attitudes and abilities, in combination, underlie competence. A
competency is a combination of attributes underlying some aspect
of successful professional performance. Competencies can be
relatively specific (where, for example, they involve a single
attribute) or relatively complex (where they involve combinations of
attributes). Thus a competency-based standard is a level of
achievement required for some area of professional practice. When
such standards are specific for a select range of areas the result is a
set of competency-based standards for the profession. (NNO
Glossary of Terms, adopted from Gonczi, A., Nagel, P., Olyver, L.
Establishing Competency Based Standards in the Profession.
NOOSR Research Paper 1. Dec. 1990. AGPS)
Competency cue
Examples of competent performance. They are neither
comprehensive nor exhaustive. They assist in assessment, self
reflection and curriculum development.
Competency domain
A cluster of competency standards that characterise a central aspect
of RAN practice.
Competency element
Sub-sections of the competency unit.
Competency unit
Major competency area of a RAN representing stand alone
functions which can be performed by any RAN practitioner.
National RAN Competencies The Challenge of Competence
43
Cultural broker
A person who is able to explain and teach about his/her culture to
people from other backgrounds. Not infrequently Indigenous Health
Workers will also explain and liaise about other cultures and
institutions to their communities.
Cultural norms
Shared rules which prescribe the appropriate behaviour for people
belonging to a particular cultural group.
Cultural safe
practitioners
Cultural safety
Cultural safety
competence
Practitioners who are aware of their own cultural traditions and the
influence these have on their practice. They have moved beyond
sensitivity and awareness of cultural difference to the ability to
review and negotiate the parameters of their practice with their
client groups. Such practitioners must have the attributes necessary
to perform and define their job in accordance with the standards set
by their profession as well as those receiving their service
(developed from Ramsden 1994).
The effective nursing of a person/family from another culture by a
nurse who has undertaken a process of reflection on own cultural
identity and recognises the impact of the nurse s culture on own
nursing practice (Nursing Council of New Zealand 1992).
the knowledge, skills and attitudes necessary to live and work
effectively and appropriately within and between cultures,
communities and professions (attributes). Its aim is to provide high
quality, safe service (performance) as defined by those people using
the service (standards) (Dowd & Eckermann, 2001).
Culture
Is more than a people s way of life . Culture tells us what is pretty
and what is ugly; what is right and what is wrong; culture influences
our preferred way of thinking, of behaviour, of making decisions.
Most importantly culture is living, breathing, changing —it is never
static (Eckermann et al 1995, 6).
Culture shock
It is that feeling of uneasiness, anxiety and stress which arises when
suddenly all our familiar cues, language, interpersonal
relationships, taste and actions appear to be out of place, suspect or
even inappropriate and we must reassess our behaviour in the light
of foreign expectations (Eckermann et al 1995, 9).
National RAN Competencies The Challenge of Competence
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Culture shock stressors
Factors which generate stress when people try to accommodate to
another culture. They include five major categories —communication
(verbal and non-verbal), mechanical differences (routines, resources,
equipment), isolation (physical, social, cultural, professional and
emotional), customs and attitudes and beliefs (Eckermann et al
1995, 137, adapted from Brink and Saunders 1976).
Customary law
The traditional system of law to which Indigenous peoples
adhere(d) to regulate relationships with the supernatural and the
land as well as interpersonal and intergroup conflicts.
Different ways of knowing Refers to different world views or frameworks for interpreting and
understanding the world in which we live.
Empowerment
Consists of effective participatory decision making and depends
both on the will to make decisions and the capacity to do so
(Spindler 1994,7). Empowerment cannot be given . We can only
create the environment in which people will wish to empower
themselves.
Facilitate
Is the process of drawing out the ideas, experience and beliefs of
individuals or a group so that they arrive at conclusions and
decisions that are really theirs and that they are willing and able to
take responsibility for (Redman 1996,9).
Health care worker
Refers to all health professionals and ancillary services that support
them.
Health care team
A group of health professionals, at times augmented by
representatives of other professional and community groups, who
share goals and work together to achieve those goals. The nature,
composition, location and functions of teams will vary. Roles and/or
tasks may be designated or negotiated. Generally teams are
characterised by a sense of loyalty and belonging to the group.
Health worker
Aboriginal and Torres Strait Islander Health Professionals who are
primarily responsible to their local community and may have
responsibilities to integrate western and traditional health
approaches and to manage difficulties emerging from this
integration
All health workers provide direct services to
individuals and families, plan to meet future needs, promote well
being and prevent ill health. However, not all workers undertake
clinical practice, as the term health is used holistically, and
includes environmental, spiritual, psychological and social well
being
(Aboriginal Health Worker and Torres Strait Islander
Health Worker National Competency Standards 1996, 7).
National RAN Competencies The Challenge of Competence
45
Primary health care (PHC)
Essential health care based on practical, scientifically sound and
socially acceptable methods and technology, made universally
accessible to individuals and families in the community through their
full participation and at a cost that the community and country can
afford to maintain at every stage of their development in the spirit of
self-reliance and self determination (WHO-UNICEF 1978).
Reflective practice
Involves a deliberate process of thinking about and interpreting
experience in order to learn from it and enhance practice (adapted
from Atkins and Murphy 1993, 32).
Self care
Individuals caring for themselves.
Self determination
Is the right to make decisions. These decisions affect the enjoyment
and exercise of the full range of fundamental freedoms and human
rights of
people (Aboriginal and Torres Strait Islander Social
Justice Commission 1993, 11)
Shared management
The antithesis of top down management , shared management
refers to the sharing of the functions of management between
members of the team within a context of learning and support. As
members of the team become more skilled the designated manager
will negotiate his/her role, placing less and less emphasis on the
areas covered by other team members newly developed skill areas
and more on the areas newly identified through negotiation (Johnson
1996, 102).
Stakeholders
Refers to individuals and/or groups (recipients as well as providers)
who have a legitimate interest in health care decision making because
they are the people most likely to be affected by a decision.
Teamwork
Commonly refers to activity within an organisation but could also
refer to working together across organisations Multidisciplinary
(or multiprofessional) teamwork was coined to describe the idea that
service providers of various professions, skills and perspectives
should work in an interdependent and collaborative way to meet the
range of needs that individuals and communities have (Auer, Repin
& Roe 1993, 171).
National RAN Competencies The Challenge of Competence
46
References
Aboriginal and Torres Strait Islander Social Justice Commission. 1993.
First Report. AGPS, Canberra.
Atkins and Murphy, 1993.
Reflection: A Review of the Literature. Journal of Advanced Nursing, 19 (8), 1188—92.
Auer, J.R., Kepin, Y. and Roe, M. 1993.
Just Change: The Cost-Conscious Manager s Tool Kit. SA Health Commission, Adelaide.
Community Services and Health Training Australia. 1996.
Aboriginal Health Worker and Torres Strait Islander Health Worker National Competency
Standards, Sydney.
Dowd, L.T. & Eckermann, A-K. 2001
Development of the National RAN Competencies. Proceedings RCNA National Conference, Nursing
Education and Employment: Regroup—Revive—Refocus. Brisbance 28—30 June 2001.
Eckermann, A-K., Dowd, L.T., Martin, M., Nixon, L., Gray, R. and Chong, E. 1995.
Binang Goonj: Bridging Cultures in Aboriginal Health. University of New England Press,
Armidale.
Johnson, S. 1996.
Management for Primary Health Care. Australian Journal of Primary Health. Interchange 2 (1),
98—109.
Kearns R. & Dyck 1. 1996.
Cultural Safety, Biculturalism and Nursing Education in Aotearoa, New Zealand in Health and
Social Care in the Community.
Keatinge, D. 1998.
Negotiated care
fundamental to nursing practice. Journal of Royal College of Nursing,
Australia. 5(1), 36—42.
National Nursing Organisation. 1998.
Glossary of Terms. Melbourne.
Nursing Council of New Zealand. 1996.
Guidelines for Cultural Safety in Nursing and Midwifery Education. Nursing Council of New
Zealand.
Nursing Council of New Zealand 1992.
Standards for Registration of Comprehensive Nurses from Polytechnic Courses. Wellington
Ramsden I. 1993.
Kawa Whakaruruhau, Culture & Safety in Nursing Education in Aotearoa, Talk given at 2nd National
Trans Cultural Nursing Conference, Sydney.
Redman, W. 1996.
Facilitation Skills for Team Development, Kogan page, London.
Spindler, S. 1994.
Justice, Power and participation. Community Quarterly. 30, 4-10.
WHO/UNICEF. 1978.
Primary Health Care. Report of the International Conference on Primary Health Care, AlmaAta USSR, 6—12 September. Geneva, World Health Organisation. HFA Series No. 1.
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National RAN Competencies The Challenge of Competence
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Feedback Form
The RAN Project Team and CRANA Inc. welcomes your feedback on your perceptions of the
relevance and value of the competencies document with the accompanying video Remote Area
Nursing: The Challenge of Competence in your workplace and/or community.
Your feedback will be taken into account as part of the review of the implementation and use of
the competencies planned for 2002.
Please forward your comments on this form (with extra pages if needed) to:
The Director
Centre for Research in Aboriginal and
Multicultural Studies (CRAMS)
Faculty of Education, Health & Professional Studies
University of New England
ARMIDALE NSW 2350
1.
Background Information:
State/Territory in which employed:
Position:
Time in current position:
Time in RAN Practice:
Age:
Gender: Female/Male:
Employer:
2.
What are your main responsibilities in relation to RANs?
National RAN Competencies The Challenge of Competence
49
3.
General Comments (e.g. is the resource practical, useful, meaningful and applicable to
the situation in which you practice?)
4.
How have you used this document? (e.g. recruitment, induction, orientation, job
descriptions, performance appraisal, curriculum development, self assessment, team
discussion, community consultation and negotiation)
5.
How have you used the accompanying video?
National RAN Competencies The Challenge of Competence
50
6.
Are the units, elements and cues comprehensive and indicative of RAN practice in
the situation in which you work? If not, please identify by number those that are
inadequate and state what areas need to be added?
7.
Is the format and language clear and concise? If not, indicate areas/terms that
cause confusion.
National RAN Competencies The Challenge of Competence
51
8.
Are there any domains of RAN practice which have not been covered in these
competencies? If so, please list.
9.
Are there any other sections of the document and/or video you would like to
comment on?
10.
In this response did you consult:
F
HWs
F
Communities
F
Colleagues
F
Other(s)
National RAN Competencies The Challenge of Competence
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