Developing Skills and Competence in Acute Care – A case study of an ‘Acute Illness’ Course, 2006-2009

Within secondary care hospital settings, acutely ill patients are exposed to the unnecessary risk of the adverse consequences and increased mortality that arise from suboptimal care. A causative factor of suboptimal care is the level of competence of practitioners caring for the acutely ill patient in their failure predominantly, to monitor, recognise or respond appropriately to the deteriorating patient. In partnership with local healthcare organisations, the acute illness course, on which this study was based, was conceived and implemented. The aim of the course was to provide an academic and clinical experience that focused on the development of skills and competence of post-registration practitioners within non-critical care settings. The first cohort commenced their course in 2006. This study investigated the development of this experience, focussing on students’ skills and competence following their exposure to a variety of teaching, learning and assessment strategies that had been employed. Competence is one of the most commonly used words in healthcare education yet it is a nebulous concept that is defined in diverse ways by different people. The concept of competence provided the theoretical framework that was analysed and applied within the field of acute care. An educational evaluation using a case study approach was used employing interviews for data collection purposes. The case study examined the many variables of interest within the student experience while maintaining a continuous interaction and dialogue between the theoretical and conceptual dimensions that were being studied. This inquiry opened by interviewing former students of the acute illness course. The aspects that were explored included, students’ characteristics, motivations and perceptions of the teaching, learning and assessment methods they had encountered. Of particular interest was the influence of these on the students’ development in clinical practice. Triangulation was adopted through interview data derived from both the former students and their managers. The study critically analysed the principle dynamics that influenced students learning in academic and practice settings. The findings demonstrated the intricate synergies that comprised this exercise in professional development. Motivation, emotional responses and performance were often influenced by the experience. The eclectic mix of learning methods that were used were thought beneficial by the study participants, who found that both the theoretical and the clinically related content of the course to be entirely relevant to their clinical practice. The study established that choice, facilitation and feedback through mixed learning and assessment methods leads to confidence and empowerment that positively influence registered nurses’ competence in clinical practice. It concluded that in this case, practitioners’ continuing professional development was influenced by interlocking concepts that supported the acquisition and maintenance of both their confidence and competence and as a consequence, stood to improve the care of acutely ill patients.