Carolyn Brown

Lamar University

Theoretical Foundations


Dr. Stacey Knight

June 19, 2016


Competency has become one ofthe most relevant concepts in all professions. Analyzing andunderstanding the concept of competency is important because it willhelp nurses address challenges and changes that are emerging in thehealth care sector. Previous studies have shown that competency ischaracterized by the use of the latest scientific evidence andinnovative strategies to enhance efficiency, quality of care, patientsafety, and treatment outcome. Some of the key defining attributes ofthe concept of competency include knowledge, personal initiative,ethics, and self-reflection. Antecedents of the concept of competencyin nursing include reforms in nurse educational programs, thewillingness to apply innovative approaches, teachers of nurses, andthe use of evidence-based practices. Its consequences include anincrease in treatment outcome, client safety, and patientsatisfaction. A structured interview with nurses can be used as aneffective tool to measure the concept of competence.

Key words: Competency,defining attributes, concept analysis, model case, antecedents,empirical referents.

Competency inBasic Nursing Skills: A Concept Analysis

Competency is among the mostrelevant concepts in the health care sector, but is barely understoodby nurses (Stevens, 2013). Therefore, the aim of this paper is toprovide a comprehensive analysis of the concept and provideinformation that can help nurses comprehend and utilize competency inaddressing emerging health care challenges and delivering qualitycare to their clients. A successful analysis of the concept will playa critical role in advancing the nurses’ understanding of theconcept and their ability to apply it in their daily practices.

For the purpose of thisanalysis I utilized a framework provided by Walker Avant (2011). This framework simplifies a complex method with eight steps which Ifollowed (a) selecting a concept, (b) defining the purpose of theanalysis, (c) defining attributes, (d) constructing a model case, (e)defining anecdotes and consequences, (f) defining empiricalreferents, (g) importance in nursing practice. (Walker &amp Avant,2011). Key words used in literature search include concept analysis,competency, basic skills, and patient safety. Definitions werecollected and reviewed from English dictionaries and internetsearches for this analysis.

Understanding the concept ofcompetency is important because the health care sector has changedsignificantly. A modern health care sector is characterized by anincrease in demand for quality care, integration of technology intohealth care practices, an emphasis on the importance of usingevidence-based practices, and the emergence of new medical challenges(Stevens, 2013). By understanding the concept of competency, nurseswill be able to address the new trends.

The concept of competency hasnumerous uses in the health care sector. The concept can be used todescribe the ability of nurses to deliver services that meet thespecific expectations of clients, indicate the capacity to deal withnew health-related challenges, the use of innovative strategies toenhance efficiency, and application of the latest scientific evidenceto inform the process of delivering health care (Stevens, 2013).

Literature Review

The call for competency in thehealth care sector underscores the need to use o innovativeapproaches in delivering health care services. According to Akenroye&amp Kuenne (2015) application of innovative techniques is among thekey feature of a competent nurse. Innovation helps health careprofessionals in addressing emerging challenges using the mosteffective diagnosis, treatment, and other therapeutic procedures.Innovative approaches are characterized by collaboration,cooperation, effective leadership, and knowledge management (Akenroye&amp Kuenne, 2015). The use of innovative strategies should beencouraged in the nursing schools in order to prepare graduates for adynamic working environment (Edwards &amp O’Connor, 2011). Theability of competent nurses to apply innovation in their dailypractices enhances their effectiveness, quality of care, and clientsatisfaction.

Collaboration among the healthcare professionals and reforms in the nursing educational programsplay a critical role of advancing competency. The formation ofinter-professional teams facilitates the process of sharing researchfindings among the health care professionals, which leads to adoptionof evidence-based practices. According to Stevens (2013) competencythat is derived from evidence-based practices focuses on theutilization of knowledge in facilitating clinical decision making.This enhances the quality of health care services. This type ofcompetency helps the health care professionals adopts practices thatare consistent with the current knowledge.

Although the need to embracecompetency is emphasized in nearly all fields of profession, theprocess of producing competent employees starts from the institutionsof learning. Educational reforms that lead to the development of acomprehensive and up-to-date curriculum produce graduates who arecompetent. A study conducted in the field of psychology revealed thata training curriculum influences the quality of graduates and theirability to demonstrate competency when they join the labor market(Hunsley &ampBarker, 2011). Therefore, the level of competency of anindividual employee can be traced back to college.

Defining Attributes

Personal initiative is acrucial attribute in nursing competency. As most nurses workautonomously, it is up to the individual’s own ethics to ensureproficiency in skills and patient safety. As skills are updated,changed or revised, nurses have the responsibility to stay abreast ofthese variables to enhance safely. Who is better to take initiativesfor patients than the nurses, who are the first ones to recognizechanges in our patients?

Knowledge is anotherattribute in the competency of nursing skills. Nurses are testedassessed, evaluated and monitored on a regular basis. Without thecontinuity of education, nurses may be unaware of changes in basicskills. Yet, as an evidenced based practice nursing skills areconstantly being revised. It may well be that some of the unitmeetings should be centered on updates of skills to ensure staff isinformed and updated with any revisions. Many nurses are stillpracticing the way they learned no matter how outdated their practicemay be.

Ethics in practice is ofutmost importance in nursing competencies. Any breach in protocolmay result in a sentinel event. It is critical that the skill beretaught, reassessed, and evaluated for competency, accuracy andproficiency.

Self-reflection is essentialin any concept of change. Most people do not like any simulation ofchange, unless it is for their own good. As nurses give care toothers, it is imperative that updates or changes in basic nursingskills be initiated once noticed. It can be uncomfortable to adapt tothese changes, but for patient safety all must comply.

Model Cases

Model cases are used todefine and explain concepts as they would appear in real worldsituations. The concept of competency will be analyzed using a modelcase, a borderline case and a contrary case. These cases willillustrate the application of different attributes of competency(Walker &amp Avant, 2011).

A student nurse teaching along time nurse on a unit of a change in a basic nursing skillillustrate a new method of drug administration. The student and theinstructor entered the room with the Registered Nurse to give aLovenox injection. The Registered nurse went to pull up themedication on the electronic health record. The nurse asked thestudent to choose the abdomen as the site of the injection. Thestudent looked at the instructor and said, “I thought Lovenox wasnow to be given in the love handles as we were taught to remember itby L for love handles, and I cannot chart the site until theinjection is actually given”. After verification of correctness bythe instructor, the Registered nurse said that she was unaware of thechange in injection site for that medication. After verification thestudent, instructor, and the Registered Nurse all agreed that thesite to be documented would be subcutaneous, which was recommended bythe manufacturer, instead of the abdomen. The next day theRegistered nurse was found instructing other nurses as well asstudents in the proper administration of the medication Lovenox. Theregistered nurses demonstrated the importance of personal initiative,knowledge, ethics, and self-reflection regarding changes in basicnursing skills, all of which are the key attributes of the concept ofcompetency that enhance the safety of patients.

Borderline case

A borderline case is similarto a model case, but it lacks some attributes of the concept that isbeing analyzed (Walker &amp Avant, 2011). A student nurse was aboutto perform an indwelling Foley catheter. As the student opened thesterile package and started preparing for the procedure the emergencyroom (ER) nurse reminded her to test the balloon. The instructoradvised the nurse that the testing of the balloon was no longerrequired, as per the findings of studies developed from evidencedbased-based practices. However, the ER nurse said that she could notunderstand that and would much rather know about a problem with theballoon before it was inserted instead of after. She came out of thepatient’s room complaining to the other nurses saying that shewould continue to test the balloon regardless of the changes in theskill requirements. She decided not to take the initiative and foundno problem in the ethics of her decision, continuing the skill as shehas learned it. The nurse acquired the new knowledge, but failed totake an initiative to put into practice.

Contrary case

A contrary case fails to meetany of the attributes of the concept that is being analyzed (Walker &ampAvant, 2011). I went with my sister to the emergency room oneafternoon as she was suffering from a bowel obstruction. As a nurse,I noticed the emergency room nurse inserting the nasal gastric tubewith incorrect placement measurements. I was promptly asked to leavethe room while the skill was completed. No follow up x-ray was donefor accurate placement assessment. As my sister remained on a nothingby mouth status (NPO), in preparation for her surgical procedure thenursing staff emptied suction container as my sister became weakerand weaker from dehydration. When the provider made the rounds andwas notified of the problem, placement of the nasogastric tube waschecked and verified to be in the small intestine. Because the nursefailed to perform a basic nursing skill with competence a patientsuffered unnecessarily. This case contained none of the attributesidentified in the competency in basic nursing skills concept, andcaused harm to a patient as a result.

Antecedents and consequences

The term “antecedents”refers to events that take place just before the occurrence of agiven concept. The word “consequences”, on the other hand, isused to describe the results that can be directly attributed to theoccurrence of the concept (Hunsley &ampBarker, 2011). The keyantecedents of the concept of competency in nursing include reformsin nurse educational programs, teachers of nurses, the willingness toapply innovative approaches, and adoption of evidence-based practices(Stevens, 2013). The willingness of individual nurses to applyinnovative approaches in their practice is associated with anincrease in knowledge, skills, and efficiency, all of which enhancethe competency of the health care professional. Educational programsare significant tools that are used to prepare nurses before theystart practicing. A review of these programs in order to include theideas of safe, effective, and efficient service delivery help nursesdemonstrate a high level of competency.

Some of the key consequencesof embracing competency in the field of nursing include animprovement in patient outcome, patient safety, quality, efficiency,and patient satisfaction in the delivery of health care services(Stevens, 2013). Competent nurses possess skills that allow them todeliver health care services that address the specific health careissues that they clients are facing. In addition, the ability ofcompetent nurses to apply evidence-based results in a decline incases of medical errors, which enhances the treatment outcome, clientsafety, and patient satisfaction (Stevens, 2013). Innovativeapproaches help competent nurses deliver health care services in amore efficient way.

Empirical referents

The term “empiricalreferents” describe processes that the stakeholders in the field ofnursing use to measure the concept of competency. Approaches that areutilized in the measurement of competency should be valid, reliable,comprehensive, and objective. However, studies have shown that thereis a limitation in the number of measurement tools that can be usedto measure the gap between nurse education and practice, which is asignificant challenge facing the stakeholders in the field of nursing(Stevens, 2013). For example, the process of using portfolios toillustrate ongoing competency does not have a well defined referentfor competency. This shortage justifies the need for the developmentof measurement processes by which the portfolios can be evaluated andstandardized in order to provide measurable results.

The current body of literaturesuggests that the use of nursing outcomes as the foundation offoundation of competency-based curriculum for undergraduate canresult in more objective measurement.

Similarly, a consideration ofa set of progressive difficult skills in a given semester contributestowards objective measurement of competency (Stevens, 2013). Astructured interview is an effective tool that can help thestakeholders in the health sector measure competency moreobjectively. The tool captures all the skills (including patientcare, medical knowledge, practice-based learning, system-basedpractice, level of professionalism, and medical management) thatcharacterize a competent nurse. The inclusion of a wide range ofskills increases objectivity in the process of measuring the conceptof competency.

Application of the concept ofcompetency in evidence-based practice

The concept will be used toassess the nurse’s ability to meet the three competency standards,including professional practice, critical thinking as well asanalysis, and collaborative and therapeutic practice. The standard orprofessional practice will guide and measure the ability of a nurseto carry out their professional, ethical, and legal responsibilitiesin a manner that demonstrates accountability for practice,satisfactory knowledge base, and constancy of practices with the law(Grealish, 2014). Key indicators of professional practice standardinclude compliance with legislations that regulate the field ofnursing and ability to practice within a professional framework.

The standard of criticalthinking and analysis, which relates to the value of evidence,professional development, and self-appraisal, will help the nurseapplying evidence-based practices on a daily basis. Criticalthinking, which is among the key elements of competency, will bedemonstrated by the ability to operate within the evidence-basedframework, the use of research to enhance health outcomes,application of the best evidence as well as nursing expertise, andthe utilization of analytical skills to assess the quality ofavailable health information before using it to guide the process ofdelivering health care to patients (Grealish, 2014). In this context,the concept of competency will be used to guide the process ofsourcing, evaluating, and applying available research evidence toenhance the health of patients.

Competent nurses understandthe significance of establishing therapeutic relationships that arewithin professional boundaries. The concept of competency will beused as a guiding in the process of establishing interdisciplinaryteams within the health care setting and helping members of the teamestablish a goal-oriented relationship (Grealish, 2014). A successfulcollaboration among members of the health care team will require eachof them to apply effective communication, support each other inmaking informed decisions, and work together to inform the process ofpolicy development. This collaboration will create an environment inwhich health care professionals (including nurses) can share thelatest evidence that can inform their daily practices.

However, the process ofadopting evidence-based practices in the health care setting willrequire the change of attitude and traditional way of deliveringhealth care services. Based on Kant Lewin’s theory of change, itcan be predicted that the process of change will face restrainingforces, such as resistance from other health care professionals.Restraining forces come from individuals who prefer the status quo tochange, which is attributed to the fear of the unknown (Alligood,2014).Therefore, a change towards the adoption of evidence-based practiceswill be done progressively, using the three steps provided by Lewin’stheory of change. The first step, also referred to as unfreezing,will involve preparation of health care professionals to accept thefact that change is necessary. Preparation will be achieved byinforming the health care professionals about the importance ofembracing evidence-based practices and their potential benefits, suchas an increase in the quality of care, patient outcome, and clientsatisfaction (Sarayreh, Khudair, &amp Barakat, 2013).

The second step, moving to thenew level, will involve the actual adoption and utilization of theevidence-based competencies in an effort to enhance competency.Effective communication will facilitate the process of informing thestakeholders about the progress of change and helping them feelhighly connected to each other (Sarayreh, Khudair, &amp Barakat,2013). Platforms for sharing latest evidence in the field of healthcare will be created. For example, the establishment of a journalclub will help the health care professionals meet regularly to reviewjournal articles that have been published recently.

The third step, refreezing,will involve the process of ensuring that the health careprofessionals start considering evidence-based practices as part oftheir everyday business (Sarayreh, Khudair, &amp Barakat, 2013).This will be followed by the process of adjusting the standardoperating procedures and policies in order to ensure that the conceptof competency and the idea of evidence-based practices areinstitutionalized and integrated into organizational culture.


Competency is a challengingand exciting concept in nursing that help the health careprofessionals deal with emerging health care challenges. Competencyamong nurses can be enhanced through reforms in nursing educationalprograms, application of innovative approaches, adoption ofevidence-based practices, and transformative leadership. Theimportance of the concept of competency should be emphasized rightfrom the nursing schools to the workplaces where it is practiced inreal-life scenarios. Competent nurses should be able to demonstrate awide range of skills, including the ability collaborate withprofessionals from other health units, analyze research evidencecritically, and apply the scientific research in daily activities. Asuccessful application of the concept of competency in the healthcare sector leads to an increase in efficiency, patient outcome,client satisfaction, and the overall quality of care.


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Alligood,M. R. (2014). Nursing theory:Utilization and application (5th ed.).St. Louis, MO.: Mosby Elsevier. ISBN: 978-0-323-09189-3.

Edwards, J. &amp O’Connor,A. (2011). Improving technological competency in nursing students:The passport project. TheJournal of Educators Online,8 (2), 1-20.

Grealish, L. (2014). Howcompetency standards became the preferred national technology forclassifying nursing performance in Australia. AustralianJournal of Advanced Nursing,30 (2), 20-31.

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