Subject benchmark statements: Nursing
This Subject benchmark statement provides a means of describing the nature and characteristics of programmes of study and education in nursing in Scotland. It also represent general expectations about standards for the award of qualifications at a given level and articulates the attributes and capabilities that those possessing such qualifications should be able to demonstrate.
Subject benchmark statements are used for a variety of purposes. Primarily, they are an important external source of reference when new programmes are being designed and developed. They provide general guidance for articulating the learning outcomes associated with the programme but are not a specification of a detailed curriculum. Subject benchmark statements provide for variety and flexibility in the design of programmes and encourage innovation within an agreed overall conceptual framework.
Subject benchmark statements also provide support in the pursuit of internal quality enhancement. They enable the learning outcomes specified for a particular programme to be reviewed and evaluated against agreed general expectations about standards.
Subject benchmark statements are one of a number of external sources of information that are drawn upon for the purposes of academic review* and for making judgements about threshold standards being met. Reviewers do not use subject benchmark statements as a crude checklist for these purposes however. Rather, they are used in conjunction with the relevant programme specifications, the associated documentation of the relevant professional and statutory regulatory bodies, the institution's own self evaluation documentation, together with primary data in order to enable reviewers to come to a rounded judgement based on a broad range of evidence.
The benchmarking of standards in health care subjects is undertaken by groups of appropriate specialists drawn from higher education institutions, service providers and the professional and statutory regulatory bodies. Drawing on initial work undertaken within a UK context, the statements represent the first attempt to make explicit in published form the general academic characteristics and standards of awards in nursing within the context of a devolved Scottish education system. In due course, the statements will be revised to reflect developments in the subjects and the experiences of institutions, academic review and others that are working with it.
This statement is © The Quality Assurance Agency for Higher Education 2002.
It may be reproduced by educational institutions solely for educational purposes, without permission. Excerpts may be reproduced for the purpose of research, private study, or review without permission, provided full acknowledgement is given to the subject benchmarking group for this subject area and to the copyright of the Quality Assurance Agency for Higher Education.
Electronic storage, adaptation or translation of the statement is prohibited without prior written agreement from the Quality Assurance Agency for Higher Education.
* academic review in this context refers to the Agency's new arrangements for external assurance of quality and standards. Further information regarding these may be found in the Handbook for Academic Review, which can be found on the Agency's web site.
Convener's Introduction
The main aim of the Scottish Nursing, Midwifery and Health Visitors Subject Benchmark Task Group was to develop higher education subject benchmarks that reflected the health and education sectors in Scotland. Therefore, the benchmark statements presented in this document will provide practitioner and academic curricula designers in Scotland with a framework on which to build creative and forward-looking pre-registration programmes. The benchmark statements will also provide learners with a clear guide to what a programme of preparation should enable them to do and what is required of them before they are eligible for professional registration.
The Scottish Benchmark Task Group members came from a wide range of academic and practice subject communities. It was therefore challenging for the Group members to be engaged in the diverse multi-disciplinary debate, a debate that often questioned existing beliefs, standards and ideas.
In the early stages of its work, the emergence of the triangular framework and the Task Group's endorsement of the plan to build upon the already complete UK benchmarking exercise1 gave the Group a true sense of identity, teamwork and clarity of direction. To ensure that each discipline was clearly represented the Task Group split into subject discipline groups, led by a 'champion'. The champions facilitated the subject discipline discussion and cross-referencing of the benchmark statements with the statutory competency requirements for registration. The Task Group met on pre-arranged dates, but much of the work was undertaken via electronic communication.
Also the full consultation period and consultation event provided subject communities with the opportunity to offer robust feedback which enhanced the quality of the finished documents. Therefore, it is with some confidence that the Benchmark Task Group present you with these Subject benchmark statements that meet the requirements of academic study at degree level and incorporate the statutory competency requirements for admission to the professional register.
Subject benchmark statements are an important part of the 'vocabulary for describing learning opportunities'.2 within the total quality standards framework. If you are a practitioner or an academic I encourage you to become fully conversant with the statements. Please use them when you are engaged in the development of any new curriculum design group.
I also urge you to encourage students, in the academic and practice setting, to reflect upon the relationship between the three main aspects of Professional Preparation and Development and debate with them how all three will enhance the meaningfulness of their learning.
Jennie Parry Chairperson Nursing, Midwifery and Health Visiting Scottish Benchmark group 2002.
1 Quality Assurance Agency for Higher Education (2001) Benchmark Statement: Health Care Programmes. The Emerging health professions framework. Gloucester: QAA.
2 Quality Assurance Agency for Higher Education (2001) The Framework for Qualifications of Higher Education in Scotland. Gloucester: QAA.
See also An Introduction to the Scottish Credit and Qualifications Framework page 2 (vii); The Scottish Credit and Qualifications Framework, 2001.
Foreword
This subject benchmark statement describes the nature and standards of programmes of study in nursing that lead to the subject awards made by higher education institutions in Scotland. It has built on the valuable work already done in which nursing programmes in other parts of the UK have been benchmarked1. The Scottish statement not only strongly endorses this previous work, but has also incorporated parts of it, and has drawn upon it in various ways that renders the Scottish statement congruent with the UK context, both in terms of specificity to the nursing profession and to the possibility of an emerging health professions framework.
Within such a UK context, Scotland has a devolved education system. This is reflected in the fact that the Scottish Credit and Qualifications Framework (SCQF) is slightly different from that of its counterparts in the rest of the UK2. In particular, Scotland has continued to embrace the development and award of the Scottish ordinary degree for a range of vocational and professional programmes of preparation. This is further reflected in the fact that the Scottish Executive Health Department, through its contracting arrangements with higher education institutions, has provided the opportunity for pre-registration students of nursing to qualify at ordinary degree level. The Scottish benchmarking group has therefore taken into account that pre-registration nursing students in Scotland may qualify at three different academic levels on the SCQF, being that of diploma of higher education, ordinary degree or honours degree.
The Diploma of Higher Education in Nursing remains the threshold standard for pre-registration nursing programmes in Scotland, but to this must be added the fact that the Scottish Diploma of Higher Education in Nursing attracts 60 credit points at SCQF level 9 (SHE level 3) which is Scottish ordinary degree level. It is for these reasons that the Scottish statement for nursing has been designed and presented in a way that differs slightly from its counterparts in the rest of the UK, while, as noted above, still remaining congruent with the overall purpose and value of the work already undertaken, including that of an emerging health professions framework.
The design and presentation of the Scottish Subject benchmark statement for nursing has also been influenced by the benchmark information pertaining to the standard for initial teacher education in Scotland3. In particular, the Scottish benchmarking group placed a high value on the way in which a single set of benchmarks and expected features were presented as the threshold standard for professional preparation at different levels of academic award. The group took the view that such a manner of presentation was also appropriate for the nursing context in Scotland with its three different levels of award, and therefore made the decision to proceed down that route. This will enable the different higher education providers of nursing education in Scotland to meet the threshold standards in their programme design while also facilitating the three different academic levels of provision and completion as and where appropriate.
The benchmarks for nursing in Scotland, along with the expected features of the threshold standard are set out under the following three main headings:
A Professional Knowledge and Understanding.
B Professional Skills and Abilities.
C Professional Values, Accountability and Development.
It is important to note that these three headings signify a high degree of interdependence where the academic nature of the programme meets the professional requirements of a programme that is practice-based but education led. In this respect, the Scottish benchmarking group valued the opportunity to cross reference the benchmarks and their expected features with the competencies for entry onto the professional register. This fact has also strongly influenced the template in which threshold standards are presented.
The section on teaching, learning and assessment draws attention to the central role of practice in the design of learning opportunities for students and the importance of ensuring that professional competence developed through practice is adequately assessed and rewarded. It also notes how essential it is that the integration of theory and practice is a planned process within the overall arrangements made for teaching and learning.
The statement acknowledges the need to put the prospective client/patient at the centre of the student's learning experience and to promote within that experience the importance of team-working and cross-professional collaboration and communication. Implicit in the statement are the opportunities that exist for shared learning across professional boundaries. It is essential that the opportunities that exist for shared learning in practice are optimised, as well as best use being made of similar opportunities that prevail more obviously in classroom-based activities.
This statement and the associated statements will therefore allow higher education institutions, in partnership with service providers, to make informed curriculum choices about the construction of shared learning experiences. In this context shared learning is seen as one of a number of means of promoting improved collaborative practice and addressing a range of issues which span professional accountability and professional relationships. The statement has also been written in the context of the modernisation agenda for the health service in Scotland, where the goal is that of an ever-improving service and a continuing focus on patient-centred needs in what remains a practice-based and education led preparation. In this respect, benchmarking statements strive to make education fit for purpose in a manner that augments transparency and accountability to all stakeholders.
The statement does not set a national curriculum for programmes leading to awards in nursing. It acknowledges that the requirements of the statutory regulatory body needs to be incorporated into the design of programmes. It seeks to encourage higher education institutions and service providers to work collaboratively in the design and delivery of their curricula. Its essential feature is the specification of threshold standards, incorporating academic and practitioner elements, against which higher education institutions are expected, as a minimum, to set their standards for the award.
Finally, the subject benchmark statement for nursing in Scotland has also been designed in such a way that looks to the future, both in terms of internal quality enhancement, continuing professional development and the modernisation agenda. Thus the statement that follows is seen as the first phase in an ongoing evolution of both quality systems, inter-professional collaboration, and transparency of programme content and design in a manner that is clear to all stakeholders. In this respect it is presented as a sound platform for the future of the nursing profession in Scotland.
1 Quality Assurance Agency for Higher Education (2001) Subject benchmark statement: Health care programmes - Nursing, QAA, Gloucester. The emerging health professions framework is given in Appendix One.
2 Quality Assurance Agency for Higher Education (2001) The Framework for Qualifications of Higher Education in Scotland, QAA, Gloucester. See also, Scottish Executive (2001) An Introduction to the Scottish Credit and Qualifications Framework, Edinburgh, Scottish Executive.
3 Quality Assurance Agency for Higher Education (2000) The Standard for Initial Teacher Education in Scotland: Benchmark Information, QAA, Gloucester.
Benchmark statement for nursing in Scotland
Introduction
Nursing is an applied vocational and academic discipline that is often practised in a variety of complex situations across the health-illness continuum. There are a number of definitions of nursing but few, if any, that explicitly enable a benchmark nursing statement to be identified. The variety and diversity of nursing is articulated through the specialist branch structure that enables practitioners, upon successful completion of an approved programme, to register as either an adult, child, learning disability or mental health nurse.
Nursing focuses on promoting health and helping individuals, families and groups to meet their health care needs. Nursing work involves assisting people whose autonomy is impaired, who may present with a range of disabilities or health-related problems, to perform a range of activities, sometimes acting for, or on behalf of the patient. A defining feature of nursing is that it provides twenty-four hour care with a focus on meeting people's personal and social needs within a healthcare context.
Nurses work with patients, clients, families and communities in primary care, acute and critical care, rehabilitation and tertiary care settings. The knowledge base for nursing is broad-based encompassing natural, human and social sciences, and also the humanities.
Nurses practise within a social, political and economic context. Through their Code of Professional Conduct, nurses embrace the concepts of inclusion, equal opportunities, individual rights and empowerment of patients and client groups. Professional and patient/client autonomy is a key feature of the nurse's role.
As already noted in the foreword, a key feature of the nurse's role is that of collaborative working with other professionals, and also in a facilitative manner with support workers. This latter role is of particular importance within a Scottish context where the SCQF has been designed to augment parallel developments between vocational modes of study and higher education.
Given the complex nature of nursing and diversity of health care situations encountered, nurses must be skilled practitioners, knowledgeable in a range of subjects and able to appraise and adopt an enquiry-based approach to the delivery of care. Irrespective of the academic award, individuals undertaking programmes that lead to professional registration must demonstrate achievement of the nursing competencies required by the statutory regulatory body for entry to the Register.
The study of nursing encompasses the following principles:
- a commitment to provide high quality patient-centred care;
- the development of educational programmes that enable nurses to demonstrate fitness for practice and a commitment to continuing professional development;
- a commitment to the development of new roles that support the interface between health and social care practice;
- the application of current knowledge and research to nursing practice across the health and illness continuum;
- an evolution towards role transferability in support of patient-centred care;
- a commitment to working in partnership with other professionals.
Nature and extent of programmes in nursing
Nursing is a large and complex profession and academic discipline. Twelve Scottish universities provide programmes of pre-registration nurse education which, in partnership with service providers, prepare students for entry to the professional register. These universities also provide opportunities for continuing professional development and specialist programmes of preparation beyond initial registration.
Pre-registration nursing education consists of a common foundation programme and four branch programmes to prepare nurses to work in either adult nursing; child nursing; learning disabilities nursing; or mental health nursing.
Common foundation programme
The common foundation programme is the core element that underpins each branch and is shared by all nursing students. It introduces students to the four branches but also focuses on a range of subjects within and applied to nursing that are common to all branches.
Nursing programmes involve integrated study of the knowledge, skills and values from a range of subject disciplines applied to the practice of nursing. These are outlined in this statement. Core areas within these subjects are common to all of nursing while other aspects within these disciplines are applied to specific branches. Regardless of the order that these subject areas appear in this statement, programmes within each of the four branches will place greater emphasis on certain subject areas.
Nursing competence requires the development of technical, cognitive and interpersonal skills and involves a variety of different ways of knowing and understanding. Technical skills are the most visible part of some branches of nursing while for other branches interpersonal skills are the primary focus. Interpersonal and interactive skills are needed to enable nurses to form appropriate professional relationships and for some branches the depth and breadth of interpersonal skills required is greater.
Through their educational preparation nurses become equipped to understand, contribute to, and work within the context of their profession and to analyse, adapt to, manage and eventually lead the processes of change.
Adult nursing
Central to adult nursing is a commitment to patient-centred care that recognises the need to assess physical, social, psychological and spiritual needs to maximise potential for health and well-being. This is underpinned by a philosophy which embraces partnership working with patients, carers and the multi-professional team. This approach enhances the development of values that promote independence, autonomy and reciprocity in adult health care.
Adult nurses need to understand the differing health care needs of adults within age groups that span adolescence, adulthood and older people. Care is provided for adults in a wide variety of primary, acute, continuing and rehabilitative care settings that include NHS trusts, the patient/client's own home, the workplace, the prison services and the independent and voluntary sector. Adult nurses acquire the knowledge, skills and attitudes to meet the needs of adults in all care areas, support them through programmes of care and treatment and maximise opportunities for health promotion.
A substantial part of adult nursing involves coordinating, integrating and managing care, making referrals to other members of the care team and ensuring that effective communication channels are in place to support continuity of care. In order to fulfil this role, adult nurses need to be confident to make decisions and where appropriate, challenge assumptions and practices.
Children's nursing
The developing needs of children from infancy to adolescence, in relation to physical and mental health and special needs, form the heart of children's nursing. Children's nursing is practised within a philosophy of child-focused and family-centred care in which, whenever possible, the child, parents and carers are equal partners. This partnership enhances self esteem, enables children to reach their full potential and encourages the development of autonomy in care and decision making.
Ill children present with complex multi-dimensional problems, some being life limiting or life threatening, and many which persist through childhood into adult life. These problems impact upon the child's development, choices and family life. This requires children's nurses to work collaboratively with other professionals in health and social care to promote health, minimise illness and protect vulnerable children.
Children's nurses practise within the child's own home, hospital, school, community and voluntary settings. The wide spectrum of health problems, care settings and opportunities for health promotion require nurses to demonstrate confidence and competence in child specific nursing. This involves the coordination of care and the use of refined interpersonal and communication skills with both children and adult carers, underpinned by knowledge of child development.
Children's nurses need to be politically aware, applying knowledge of health and social policy, law and ethics in order to champion the rights of children both as a group and as individuals receiving care.
Learning disabilities nursing
Programmes in the learning disabilities branch of nursing prepare nurses to work with people with a range of learning disabilities and with their families and significant others. Learning disability nurses' work is underpinned by the concepts of partnership, inclusion and advocacy. The role of the learning disability nurse, specifically, is to assist and support people to become and remain healthy, to improve their competence and quality of life, and to fulfil their potential. Learning disability nurses work with people with a spectrum of needs and abilities in a wide variety of settings, often working collaboratively with professionals from a range of health and social care agencies. This support may take place in the National Health Service (NHS), voluntary or independent sector, or in the patient/client's own home.
Mental health nursing
Programmes in mental health nursing prepare nurses to work in a branch of nursing whose precepts acknowledge that nursing is essentially a human activity which has as its core the relationship between the nurse and his/her client(s) and carers. This relationship is premised on knowledge, attitudes and skills that assist individuals with mental health problems to reach their maximum potential. The knowledge and practical skills required of the mental health nurse are those that facilitate the recognition and achievement of the interpersonal, emotional, behavioural, cognitive and spiritual needs of clients. Mental health nurses approach these in a structured way through a systematic process that embraces the concepts of client-centredness, self-reflection and self-awareness. This ensures that the nurse/client relationship is a dynamic one. The mental health nurse may be required to meet the health and/or nursing care needs of clients with acute, rehabilitative or continuing care needs or health promotion requirements within community, residential and hospital settings.
The statements in the rest of this document outline the knowledge, understanding and associated skills, and the application of these to nursing practice across all nursing branches.
Threshold standard for nursing programmes in Scotland: Elements of Professional Development
Programmes of pre-registration nursing preparation are the first step in a lifelong career of professional development. Programmes of inititial preparation for registration require to promote three main aspects of such development.
A Professional Knowledge and Understanding
B Professional Skills and Abilities
C Professional Values, Accountability and Development
The significance of placing these aspects of professional preparation within a triangle is to emphasise that they are not simply separate lists of competencies or outcomes. They are interdependent aspects of the professional preparation of the student. It is the relationship between the three aspects that constitutes a meaningful education and preparation for professional practice. Benchmark statements have been produced for each of the three aspects. Programmes will be designed to give attention to each of these and to their interaction. The Benchmark statements, as well as meeting the requirements of academic study, also incorporate the competencies that are a statutory requirement for registration.
The threshold standard for pre-registration nursing programmes in Scotland contains the following three key elements. First, the 'benchmarks' which are statements specifying the design requirements for programmes of pre-registration nursing in Scotland. Second, each benchmark contains a bullet list of 'expected features' which designate aspects of student performance that the programme is designed to achieve in relation to a particular benchmark. These 'expected features' will be used in designing assessment strategies that facilitate the integration of academic work and practice learning. Third, each benchmark has been cross-referenced to the appropriate competencies, the meeting of which is a statutory requirement for initial registration as a nurse in the United Kingdom4. In this manner the benchmarking exercise has occurred within the context of a devolved Scottish education system while still embracing the UK context of the nursing profession and its statutory requirements.
4 The statutory competencies for nursing are enumerated in Appendix Two.
Threshold standard for pre-registration nursing programmes in Scotland
A Professional Knowledge and Understanding
Benchmark
The Programme of Preparation will enable students to:
A1 Interpret and reflect upon the nature of professional nursing and forms of nursing knowledge and practice.
Expected features
By the end of the programme students will be able to:
- Understand and discuss professional nursing issues such as advocacy, accountability, informed consent, autonomy, partnerships and collaborative working within the context of clinical governance.
- Engage in interpretation and analysis of changing philosophical and historical perspectives in nursing and nursing theories appropriate to different client groups.
- Apply different nursing methods and protocols as appropriate for different patient and client groups.
- Make appropriate use of nursing, medical, and healthcare language and concepts.
- Use the different approaches to and methods of care appropriate to different stages of the human lifespan.
- Analyse the importance of research-based evidence for specific patient and client groups.
- Appraise nursing knowledge as informed by different research methods and other forms of scholarly enquiry.
Competencies
Cross reference to professional competencies
1.1, 1.5, 2.2, 2.4, 2.5 and 2.8
Benchmark
The Programme of Preparation will enable students to:
A2 Understand the appropriate life and human sciences that underpin and contribute to nursing practice and health promotion.
Expected features
By the end of the programme students will be able to:
- Attain the required level of knowledge of anatomy, physiology, genetics, immunology, microbiology, pharmacology and nutrition.
- Relate elements of the life and human sciences to patient/client assessment, investigative procedures, therapeutic interventions and clinical nursing skills.
- Utilise knowledge of pathophysiology and its relation to nursing practice for particular health problems.
- Demonstrate how knowledge of pathophysiological processes may inform health promotion strategies.
- Demonstrate knowledge of physiological changes that occur throughout different stages of the lifespan.
Competencies
Cross reference to professional competencies
2.5 and 2.6
Benchmark
The Programme of Preparation will enable students to:
A3 Understand the appropriate health and social sciences that underpin and contribute to nursing practice and health promotion.
Expected features
By the end of the programme students will be able to:
- Recognise the contribution of the social sciences to an understanding of health variables: eg psychology, sociology, epidemiology, health and social policy.
- Demonstrate understanding of different models of health and illness and health-belief systems.
- Demonstrate knowledge of the psychophysiology of stress and its implications for nursing practice and health promotion.
- Demonstrate knowledge of how socio-economic and lifestyle variables may affect health and health outcomes.
- Demonstrate knowledge of the purpose and concepts of epidemiology and how it informs healthcare interventions and public health strategies.
- Discuss the complexity of and the variables involved in health economics.
- Reflect upon the contribution of the social sciences to caring for those who are experiencing loss, significant change or bereavement.
- Relate elements of the social sciences to patient/client assessment, investigative procedures, therapeutic interventions and nursing skills.
Competencies
Cross reference to professional competencies
1.2, 1.3, 2.3, 2.4, 2.6, 2.8 and 3.2
Benchmark
The Programme of Preparation will enable students to:
A4 Reflect upon the centrality of, ethics, law and the humanities for professional nursing practice.
Expected features
By the end of the programme students will be able to:
- Understand the ethical and legal responsibilities of professional nurses.
- Demonstrate knowledge of human rights leglisation and its implications for professional nursing practice.
- Engage in an exploration of different ethical theories, ethical dilemmas and the nature of moral reasoning with reference to care.
- Discuss the political and social context within which the provision of health and social care takes place.
- Understand and apply the values that underpin anti-discriminatory working practices.
Competencies
Cross reference to professional competencies
1.1, 1.2, 1.3, 1.4 and 1.5
Benchmark
The Programme of Preparation will enable students to:
A5 Acquire sound knowledge of nursing methods, nursing skills and healthcare management.
Expected features
By the end of the programme students will be able to:
- Apply nursing methods, protocols and care pathways to appropriate care situations.
- Understand the principles and elements of effective and therapeutic communication and interpersonal skills applied to patient and client care.
- Understand the importance and principles of evidence-based practice for the assessment, planning, delivery and evaluation of ongoing care.
- Be familiar with a range of tools, instruments and procedures used in the gathering of information and the auditing of care.
- Demonstrate an understanding of research-based evidence applicable to different patient and client groups; assimilate new concepts and think critically to assess the value of such evidence.
- Demonstrate knowledge and ability in a range of psychological and social caring skills required of patient, clients or groups.
- Demonstrate knowledge of and ability in a range of clinical and practical skills, including the safe moving and handling of patients, basic life support, and those skills necessary to intervene in emergency and challenging situations.
- Understand the principles of management and clinical governance within healthcare ogranisations.
- Demonstrate knowledge of the principles of risk management applied to different clinical situations.
Competencies
Cross reference to professional competencies
1.1, 2.1, 2.3, 2.4, 2.5, 2.6, 2.7, 3.1, 3.3 and 4.1
Benchmark
The Programme of Preparation will enable students to:
A6 Acquire knowledge and skills in handling information technology related to patient/client care, health promotion and continuing professional development.
Expected features
By the end of the programme students will be able to:
- Access healthcare research and literature databases to augment quality of care and professional learning.
- Show proficiency in the use of word processing, email, spreadsheets and databases as appropriate to patient-care and own professional learning.
- Use the internet as an information and learning resource
- Use relevant electronic patient information systems.
Competencies
Cross reference to professional competencies
3.3
Benchmark
The Programme of Preparation will enable students to:
A7 Acquire skills in numeracy necessary for safe patient and client care.
Expected features
By the end of the programme students will be able to:
- Manage numerate information relevant to the particular patient or client group.
- Carry out drug calculations and administration of drugs by appropriate routes.
- Record data appropriate to the healthcare setting.
- Report changes in patient information/data appropriately.
Competencies
Cross reference to professional competencies
1.4, 2.3, 3.1 and 3.3
B Professional skills and abilities
Benchmark
The Programme of Preparation will enable students to:
B1 Develop and maintain therapeutic relationships through the use of appropriate communication and interpersonal skills.
Competencies
Cross reference to professional competencies
2.1, 2.2, 2.3 and 2.4
Expected features
By the end of the programme students will be able to:
- Work in partnership with patients, clients and carers.
- Utilise communication and interpersonal skills when working with others.
- Provide support to patients, clients and carers in changing and stressful situations.
- Engage in, and disengage, from therapeutic relationships through the use of effective interpersonal and counselling skills.
Benchmark
The Programme of Preparation will enable students to:
B2 Utilise appropriate knowledge to identify and assess the healthcare needs of patients and clients.
Expected features
By the end of the programme students will be able to:
- Undertake a comprehensive systematic assessment using the tools/frameworks appropriate to the patient/client.
- Discern relevant information from patients/clients and carers to determine and prioritise care.
- Assess the potential for health promotion with patients, clients and carers.
- Maintain accurate records of the assessment processes.
- Adhering to the ethics of professional practice, communicate assessment findings to other relevant professionals involved in the care of particular patients and clients.
Competencies
Cross reference to professional competencies
1.2, 2.3, 2.4, 2.6, 2.9 and 2.10
Benchmark
The Programme of Preparation will enable students to:
B3 Formulate plans and strategies for meeting the healthcare needs of patients and clients, working with significant others as appropriate.
Expected features
By the end of the programme students will be able to:
- Plan nursing care in partnership with the patient and significant others.
- Provide a rationale for the nursing management plan based on the assessment.
- Use appropriate research and other evidence to underpin nursing decisions.
- Use evidence-based options to facilitate patient/client choice and inform nursing interventions.
- Incorporate health promotion strategies into the plan of care.
- Adhering to the ethics of professional practice, communicate plan to other relevant professionals involved in the care of particular patients and clients.
Competencies
Cross reference to professional competencies
2.3, 2.4, 2.6, 2.7 and 2.8, 2.9 and 2.10
Benchmark
The Programme of Preparation will enable students to:
B4 Deliver safe, evidence-based care to patients, clients and families across a variety of care settings.
Expected features
By the end of the programme students will be able to:
- Apply theories, concepts and principles of nursing to deliver patient-centred care for individuals, groups, familes and communities.
- Provide safe and sensitive care through the use of clinical and practical skills, and knowledge of current best practice.
- Prioritise care-delivery on an ongoing basis.
- Recognise potential risk and intervene to prevent, where possible, complications occurring.
- Practise in a manner that maintains human dignity, informed consent, human rights and professional responsibilities.
- Apply evidence-based knowledge to inform nursing care decisions, and demonstrate safe clinical judgement across a range of situations.
- Analyse and interpret relevant health education/promotion information and use this knowledge to promote the health and well-being of patients, clients and groups.
- Create and use opportunities to promote health and well-being of patients/clients and groups.
- Identify and manage challenging situations.
- Interpret and present information, including numerical data, in a clear and concise manner.
- Use information technology applied to the needs of the patient, client or client group.
- Maintain accurate records of all care delivered, and communicate to team members and appropriate others.
Competencies
Cross reference to professional competencies
1.5, 2.1, 2.2, 2.3, 2.5, 2.6, 2.7 and 2.8, 2.9 and 2.10
Benchmark
The Programme of Preparation will enable students to:
B5 Engage in an ongoing evaluation of all care delivered, and change the plan of care as appropriate.
Expected features
By the end of the programme students will be able to:
- Document and evaluate the outcomes of nursing and other interventions and communicate to team members and appropriate others.
- Reflect on practice to appraise and evaluate the effectiveness of nursing care.
- Interpret and respond to significant changes in health, medical, psychological or social status in patients and clients under care.
- Recognise and respond to situations in which quality of care may be compromised.
Competencies
Cross reference to professional competencies
2.6, 2.7 and 2.8, 2.9 and 2.10
Benchmark
The Programme of Preparation will enable students to:
B6 Engage in teamwork, multiprofessional, inter-agency and collaborative working.
Expected features
By the end of the programme students will be able to:
- Demonstrate ability to engage in effective team working.
- Communicate effectively to promote partnerships in the planning and delivery of care.
- Work with professional and support staff and delegate care appropriately.
- Demonstrate the ability to work collaboratively with other professionals recognising their different roles, skills and possible different value bases.
- Maintain effective interactions with relevant external agencies.
Competencies
Cross reference to professional competencies
3.2 and 3.3
C Professional values, accountability and development
Benchmark
The Programme of Preparation will enable students to:
C1 Value and demonstrate a commitment to promoting health and social care for individuals, families and communities irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political beliefs.
Expected features
By the end of the programme students will be able to:
- Treat patients and clients as unique, whole individuals with specific needs, desires and abilities.
- Demonstrate commitment to practising in a sensitive and non-discriminatory manner that promotes the primacy, dignity, welfare and human rights of patients, clients and carers.
- Demonstrate a commitment to social inclusiveness and anti-discriminatory practice in access to health and social care across different clinical environments and community settings.
- Practise in a manner that respects patient confidentiality and adheres to the Data Protection Act and access to medical records.
- Adhere to the professional code of conduct for nurses, midwives and health visitors.
- Understand and adhere to the requirements and standards of the professional statutory body.
- Practise in accordance with the professional, ethical and legal framework.
Competencies
Cross reference to professional competencies
1.1, 1.2, 1.3, 1.4, 1.5, 2.1 and 2.2
Benchmark
The Programme of Preparation will enable students to:
C2 Understand the importance and requirements of professional practice and accountability in different healthcare settings and employer contexts.
Expected features
By the end of the programme students will be able to:
- Demonstrate accountability for nursing care delivered, taking into account social, spiritual, cultural, legal, political and economic factors.
- Manage themselves, their practice, and that of others, recognising their own abilities and limitations.
- Demonstrate sound clinical judgement across a range of situations.
- Articulate and justify decision-making processes associated with managing practice.
- Delegate care to others, as appropriate, ensuring effective supervision and monitoring, and safe practice.
- Transfer knowledge and skills to a variety of healthcare settings and unexpected situations.
- Contribute to public protection by creating and maintaining a safe environment of care, and contribute to the development of protocols to enhance quality provision of care.
- Initiate appropriate actions in emergency situations in accordance with employers' guidelines, policies and protocols.
Competencies
Cross reference to professional competencies
1.1, 1.2, 1.4, 1.5, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 3.1 and 3.3
Benchmark
The Programme of Preparation will enable students to:
C3 Value themselves as growing professionals by taking responsibility for their lifelong learning, reflective practice and professional development.
Expected features
By the end of the programme students will be able to:
- Demonstrate a commitment to continuing professional development.
- Engage in reflection upon own professional learning needs and take steps to meet these.
- Apply a knowledge-base to support and teach others.
- Engage in clinical supervision and the developmental aspects of clinical governance.
- Recognise and reflect upon the need for changes in practice from best available evidence.
- Engage in reflective thinking that contributes to advancing practice.
Competencies
Cross reference to professional competencies
1.1, 2.5, 4.1 and 4.2
Teaching, learning and assessment
Decisions about the strategies and methods for teaching, learning and assessment are for institutions to determine, but should complement the learning outcomes associated with health profession programmes. It is not for benchmark statements to promulgate any one, or combination of, approaches over others. However, this statement promotes an integrative approach to the application of theory and practice. It underlines the significance attached to the design of learning opportunities that facilitate the acquisition of professional capabilities and to assessment regimes that ensure these are being both delivered and rewarded to an appropriate standard.
In developing the curriculum the relationship between theory and practice will require the use of practice in simulated and health and social care settings. Standards for preparing supervisors and assessors of practice should be explicit and conform to the professional regulatory bodies recommendations.
Fundamental to the basis upon which pre-registration students are prepared for their professional career, is the provision of programmes of academic study and practice-based learning which lay the foundation for career-long professional development and lifelong learning to support best professional practice and the maintenance of professional standards.
The learning processes in nursing can be expressed in terms of four interrelated themes.
Cognitive and conceptual
Programmes should develop cognitive skills in students, eg the ability to reconstruct knowledge and apply it to individual situations. Such skills should be developed through a variety of teaching and learning methods in which students are encouraged to become actively and practically engaged with the process.
Clinical and technical
Nursing skills should be developed in both the university and the practice setting. These skills should be acquired through developmental learning experiences that are structured, supervised and assessed. Students should receive formative and summative judgements and feedback on their performance throughout the programme.
Nursing social and personal context
The programme should enable students to develop an awareness of the cultural diversity, values, beliefs and social factors that affect the context of nursing. This should be achieved from both theoretical and practice perspectives and by exposing students to clinical practice in a wide variety of settings.
Generic and enabling skills
Programmes should be designed to facilitate students' acquisition of effective communication skills, team working, problem solving, the use of IT, research methodology and critical reasoning. The generic nature of these skills should enable them to be achieved through inter-professional education where their acquisition should be through activity based experiences.
The assessment strategy
Methods should match the teaching and learning strategy, meet learning outcomes and encompass a wide variety of tools. Academic assessment should be designed to develop and test cognitive skills drawing on the context of practice and reflecting the learning and teaching methods employed. Methods should normally include case study presentations and analyses, practice-focused assignments, essays, project reports, clinical assessments and examinations of a written or practical nature. The assessment of competence to practise should be determined in partnership between nursing lecturers and placement staff. Professional registration is dependent upon meeting both statutory regulatory body assessment requirements and university requirements.
Appendix One
An Emerging Health Professions Framework
The subject specific statements for nursing have been set within the emerging health professions framework outlined below. As indicated in the foreword, this framework developed as a result of the benchmarking work undertaken collaboratively by 11 different health professional groups. Further evolution of the framework is anticipated through a second phase of the project which will address its goodness of fit with a range of other health and social care professions subject benchmark statements.
A Expectations of the health professional in providing patient/client services
This section articulates the expectations of a registered professional within health and social care services. It describes what is regarded as a minimum range of expectations of a professional that will provide safe and competent practice for patients/clients in a variety of health and social care contexts.
A1 Professional autonomy and accountability
The award holder should be able to:
- maintain the standards and requirements of professional and statutory regulatory bodies;
- adhere to relevant codes of conduct;
- understand the legal and ethical responsibilities of professional practice;
- maintain the principles and practice of patient/client confidentiality;
- practise in accordance with current legislation applicable to health care professionals;
- exercise a professional duty of care to patients/clients/carers;
- recognise the obligation to maintain fitness for practice and the need for continuing professional development;
- contribute to the development and dissemination of evidence-based practice within professional contexts;
- uphold the principles and practice of clinical governance.
A2 Professional relationships
The award holder should be able to:
- participate effectively in inter-professional and multi-agency approaches to health and social care where appropriate;
- recognise professional scope of practice and make referrals where appropriate;
- work, where appropriate, with other health and social care professionals and support staff and patients/clients/carers to maximise health outcomes;
- maintain relationships with patients/clients/carers that are culturally sensitive and respect their rights and special needs.
A3 Personal and professional skills
The award holder should be able to:
- demonstrate the ability to deliver quality patient/client-centred care;
- practise in an anti-discriminatory, anti-oppressive manner;
- draw upon appropriate knowledge and skills in order to make professional judgements, recognising the limits of his/her practice;
- communicate effectively with patients/clients/carers and other relevant parties when providing care;
- assist other health care professionals, support staff and patients/clients/carers in maximising health outcomes;
- prioritise workload and manage time effectively;
- engage in self-directed learning that promotes professional development;
- practise with an appropriate degree of self-protection;
- contribute to the well-being and safety of all people in the work place.
A4 Profession and employer context
The award holder should be able to:
- show an understanding of his/her role within health and social care services;
- demonstrate an understanding of government policies for the provision of health and social care;
- take responsibility for his/her own professional development;
- recognise the value of research and other scholarly activity in relation to the development of the profession and of patient/client care.
B The application of practice in securing, maintaining or improving health and well-being
All health care professionals draw from the knowledge and understanding associated with their particular profession. This knowledge and understanding is acquired from theory and practice. It forms the basis for making professional decisions and judgements about the deployment in practice of a range of appropriate skills and behaviours, with the aim of meeting the health and social care needs both of individual clients/patients and of groups, communities and populations. These decisions and judgements are made in the context of considerable variation in the presentation, the setting and in the characteristics of the client/patient health and social care needs. They often take place against a backdrop of uncertainty and change in the structures and mechanisms of health and social care delivery.
Sound professional practice is essentially a process of problem solving. It is characterised by four major phases:
- the identification and analytical assessment of health and social care needs;
- the formulation of plans and strategies for meeting health and social care needs;
- the performance of appropriate, prioritised health promoting/health educating/caring/diagnostic/therapeutic activities;
- the critical evaluation of the impact of, or response to, these activities.
B1 Identification and assessment of health and social care needs
The award holder should be able to:
- gather relevant information from a wide range of sources including electronic data;
- adopt systematic approaches to analysing and evaluating the information collected;
- communicate effectively with the client/patient, (and his/her relatives/carers), group/community/population, about their health and social care needs;
- use a range of assessment techniques appropriate to the situation and make provisional identification of relevant determinants of health and physical, psychological, social and cultural needs/problems;
- recognise the place and contribution of his/her assessment within the total health care profile/package, through effective communication with other members of the health and social care team.
B2 Formulation of plans and strategies for meeting health and social care needs
The award holder should be able to:
- work with the client/patient (and his/her relatives/carers), group/community/population, to consider the range of activities that are appropriate/feasible/acceptable, including the possibility of referral to other members of the health and social care team and agencies;
- plan care within the context of holistic health management and the contributions of others;
- use reasoning and problem solving skills to make judgements/decisions in prioritising actions;
- formulate specific management plans for meeting needs/problems, setting these within a timescale and taking account of finite resources;
- record professional judgements and decisions taken;
- synthesise theory and practice.
B3 Practice
The award holder should be able to:
- conduct appropriate activities skilfully and in accordance with best/evidence-based practice;
- contribute to the promotion of social inclusion;
- monitor and review the ongoing effectiveness of the planned activity;
- involve client/patient/members of group/community/population appropriately in ongoing effectiveness of plan;
- maintain records appropriately;
- educate others to enable them to influence the health behaviour of individuals and groups;
- motivate individuals or groups in order to improve awareness, learning and behaviour that contribute to healthy living;
- recognise opportunities to influence health and social policy and practices.
B4 Evaluation
The award holder should be able to:
- measure and evaluate critically the outcomes of professional activities;
- reflect on and review practice;
- participate in audit and other quality assurance procedures;
- contribute to risk management activities.
C Knowledge, understanding and skills that underpin the education and training of health care professionals
The education and training of health care professionals draws from a range of well-established scientific disciplines that provide the underpinning knowledge and understanding for sound practice. Each health care profession will draw from these disciplines differently and to varying extents to meet the requirements of their specialty. It is this contextualisation of knowledge, understanding and skills that is characteristic of the learning in specific health care programmes. Consequently, in this introductory section, the attributes and capabilities expected of the student are expressed at a generalised level.
C1 Knowledge and understanding
The award holder should be able to demonstrate:
- understanding of the key concepts of the disciplines that underpin the education and training of all health care professionals, and detailed knowledge of some of these. The latter would include a broad understanding of:
- the structure and function of the human body, together with a knowledge of dysfunction and pathology;
- health and social care philosophy and policy, and its translation into ethical and evidenced based practice;
- the relevance of the social and psychological sciences to health and healthcare;
- the role of health care practitioners in the promotion of health and health education;
- the legislation and professional and statutory codes of conduct that affect health and social care practice.
C2 Skills
Information gathering
The award holder should be able to demonstrate:
- an ability to gather and evaluate evidence and information from a wide range of sources;
- an ability to use methods of enquiry to collect and interpret data in order to provide information that would inform or benefit practice.
Problem solving
The award holder should be able to demonstrate:
- logical and systematic thinking;
- an ability to draw reasoned conclusions and sustainable judgements.
Communication
The award holder should be able to demonstrate:
- effective skills in communicating information, advice, instruction and professional opinion to colleagues, patients, clients, their relatives and carers; and, when necessary, to groups of colleagues or clients.
Numeracy
The award holder should be able to demonstrate:
- ability in understanding, manipulating, interpreting and presenting numerical data.
Information technology
The award holder should be able to demonstrate:
- an ability to engage with technology, particularly the effective and efficient use of information and communication technology.
Appendix Two
Competencies to be achieved for entry to parts 12, 13, 14 and 15 of the Professional Register
1 Professional Ethical Practice
1.1 Discuss in an informed manner, the implications of professional regulation for nursing practice.
- Demonstrate a basic knowledge of professional regulation and self regulation.
- Recognise and acknowledge limitations of own abilities.
- Recognise situations that require referral onto a registered practitioner.
1.2 Demonstrate an awareness of the UKCC Code of Professional Conduct.
- Commit to the principle that the primary purpose of the professional nurse is to protect and serve society.
- Accept responsibility for own actions and decisions.
1.3 Demonstrate an awareness of, and apply ethical principles to nursing practice.
- Demonstrate respect for patient/client confidentiality.
- Identify ethical issues in day to day practice.
1.4 Demonstrate an awareness of legislation relevant to nursing practice.
- Identify key issues in relevant legislation relating to mental health, children, data protection, manual handling, health and safety etc.
1.5 Demonstrate the importance of promoting equity in patient/client care by contributing to nursing care in a fair and anti-discriminatory way.
- Demonstrate fairness and sensitivity when responding to patients/clients/groups from diverse circumstances.
- Recognise the needs of patients/clients whose lives are affected by disability, however manifest.
2. Care Delivery
2.1 Discuss methods of, barriers to and boundaries of effective communication and interpersonal relationships.
- Recognise the effect of own values on interactions with patients/clients and their significant others.
- Utilise appropriate communication skills with patients/clients.
- Acknowledge the boundaries of a professional caring relationship.
2.2 Demonstrate sensitivity in interaction with and provision of information to patients/clients
2.3 Contribute to enhancing the health and social well being of patients/clients by understanding how, under the supervision of a registered practitioner, to:
- contribute to the assessment of health needs;
- identify opportunities for health promotion;
- identify networks of health and social care services.
2.4 Contribute to the development and documentation of nursing assessments by participating in comprehensive and systematic nursing assessment of the physical, psychological, social and spiritual needs of patients/clients.
- Be aware of assessment strategies to guide collection of data for assessing patients/clients and use assessment tools under guidance.
- Discuss the prioritisation of care needs.
- Be aware of the need to reassess patients/clients as to their needs for nursing care.
2.5 Contribute to the planning of nursing care, involving patients/clients and where possible their carers, demonstrating an understanding of helping patients/clients to make informed decisions.
- Identify care needs based on the assessment of a client/patient.
- Participate in the negotiation and agreement of the care plan with the patient/client and significant others, under the supervision of a registered nurse.
- Inform patients/clients about intended nursing actions respecting their right to participate in decisions about their care.
2.6 Contribute to the implementation of a programme of nursing care, designed and supervised by registered practitioners.
- Undertake activities that are consistent with the plan of care and within the limits of own abilities.
2.7 Demonstrate evidence of a developing knowledge base that underpins safe nursing practice.
- Access and discuss research and other evidence in nursing and related disciplines.
- Identify examples of the use of evidence in planned nursing interventions.
2.8 Demonstrate a range of essential nursing skills, under the supervision of a registered nurse, to meet individuals' needs, which include:
- maintaining dignity, privacy and confidentiality; effective communication and observational skills, including listening and taking physiological measurements; safety and health, including moving and handling and infection control; essential first aid and emergency procedures; administration of medicines; emotional, physical and personal care including meeting the need for comfort, nutrition and personal hygiene.
2.9 Contribute to the evaluation of the appropriateness of nursing care delivered.
- Demonstrate an awareness of the need to regularly assess a patient's/client's response to nursing interventions.
- Provide for a supervising registered practitioner, evaluative commentary and information on nursing care based on personal observations and actions.
- Contribute to the documentation of the outcomes of nursing interventions.
2.10 Recognise situations in which agreed plans of nursing care no longer appear appropriate and refer these to an appropriate accountable practitioner.
- Demonstrate the ability to discuss and accept care decisions.
- Accurately record observations made and communicate these to the relevant members of the health and social care team.
3. Care Management
3.1 Contribute to the identification of actual and potential risks to patients/clients and their carers, to self and others and participate in measures to promote and ensure health and safety.
- Understand and implement health and safety principles and policies.
- Recognise and report situations which are potentially unsafe for patients/clients, self and others.
3.2 Demonstrate an understanding of the role of others by participating in inter-professional working practice.
- Identify the roles of the members of the health and social care team.
- Work within the health and social care team to maintain and enhance integrated care.
3.3 Demonstrate literacy, numeracy and computer skills needed to record, enter, store, retrieve and organise data essential for care delivery.
4. Personal/ProfessionalDevelopment
4.1 Demonstrate responsibility for ones own learning through the development of a portfolio of practice and recognise when further learning is required.
- Identify specific learning needs and objectives.
- Begin to engage with, and interpret, the evidence base that underpins nursing practice.
4.2 Acknowledge the importance of seeking supervision to develop safe nursing practice.
Appendix Three
Nursing Benchmark Group Membership (Scotland)
Ms Ruth Warner - Forth Valley Primary Care NHS Trust
Mrs Dorothy Armstrong - Lothian University Hospitals NHS Trust
Ms Mary Benefield - The Robert Gordon University
Mr David Benton - Grampian University Hospitals NHS Trust
Ms Mary Boyle - NHS Education for Scotland
Mr Pat Bradley - University of Stirling
Mrs Kay Currie - Glasgow Caledonian University
Mr Ron Ellis - Bell College of Technology
Mr John Gass - The Robert Gordon University
Ms Anne Hopkins - University of Wales, Swansea
Ms Kate Jackson - Napier University
Ms Celia MacKay - The Robert Gordon University
Ms Alison McLennan - The Robert Gordon University
Ms Anne Meade - Greater Glasgow Primary Care NHS Trust
Ms Wilma Phillips - University of Dundee
Ms Alna Robb - Lanarkshire Acute Hospitals NHS Trust
Mrs Barbara Robertson - University of Paisley
Mr Brian Scott - University of Stirling
Mrs A E Stalker - University of Paisley
Ms Sheena Wright - Greater Glasgow Primary Care NHS Trust
Chair
Mrs Jennie Parry - The Robert Gordon University
Development Officer
Dr John Drummond - University of Dundee
QAA Officers
Dr David Bottomley
Ms Sheila Dunn
Appendix Four
Benchmark Steering Group Membership (Scotland)
David Bottomley, QAA
Mary Boyle, NHS Education for Scotland
Helen Bryers, Midwife, Highland Acute Hospitals NHS Trust
John Drummond, University of Dundee
Rhona Hotchkiss, Clinical Standards Board for Scotland
Karen Lockhart, The Scottish Executive
Helen Mackinnon, NHS Education for Scotland
Jennie Parry, The Robert Gordon University
Jack Rae, University of Paisley
Ishbel White, Health Visitor, Greater Glasgow Primary Care NHS Trust
Acknowledgements
The Scottish benchmarking group would like offer thanks to the following for their valuable contribution to this document.
1. Professor Bart McGettrick for his input, and the members of the Initial Teacher Education Benchmarking Group for allowing their document to be used as a resource.
2. UK-wide Nursing Benchmarking Group for provision of a document that proved to be a resource of immense value in the production of the Scottish statement.
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