An Example: Course Developed in the Rotterdam Stroke Service
16.3 Core Competencies
Core Competence 1: Stroke-Specific Knowledge and Skills
The nurses have knowledge of specific symptoms of stroke and the limitations after stroke, and they are skilled in applying methods and interventions to address this.
The following knowledge aspects are specifically intended to provide care to stroke patients (see box).
Core competence 1 Knows How
At this level, nurses know how to apply the acquired knowledge to the stroke patient and their environment.
Shows How
On the third level, the student shows in a supervised situation that he/she can take care of a stroke patient. This involves knowledge and action (cognition and behavior). The student not only knows how to take care of the patient, but also shows that he/she can actually do this.
Does
The top level of the pyramid concerns independent acting in complex situa- tions. This requires an integrated whole of knowledge, skills, attitude and personal qualities. A student who works well at the level ‘Does’ can be con- sidered competent.
Knows
The students know:
– causes and symptoms of various types of stroke (i.e. infarction, TIA, bleed- ing, SAB);
– mechanisms of neurological and functional recovery of disorders and limi- tations in the field of cognition, emotion and behavior, and the interven- tions they can apply;
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– physical disorders and limitations, such as disabilities in strength, tone, coordination and balance;
– disorders and limitations of sensitivity and visibility;
– disorders and limitations in the field of communication (aphasia/dysar- thria) and the interventions they can apply;
– shoulder/hand problems and interventions;
– swallowing disorders and interventions;
– bladder/bowel problems and interventions;
– restrictions and interventions in the field of ADL;
– multidisciplinary diagnosis and treatment offered during the acute phase;
– after-care interventions (prevention, advice, information and post-treatment);
– observation methods according to ‘what/how/why’;
– purpose, necessity and methods for the multidisciplinary rehabilitative car- ing/nursing;
– phases of integrated care.
Knows How
The students recognize and know how to deal with:
– disorders and limitations in the field of cognition, emotion and behavior;
– disorders and limitations in the field of communication (aphasia/
dysarthria);
– shoulder/hand problems;
– swallowing disorders;
– bladder/bowel problems;
– restrictions in terms of ADL;
The students know how to:
– inform the stroke patient and his informal caregiver and advise on inter- ventions that promote health, well-being and/or daily functioning during the rehabilitation period;
– inform the stroke patient and his informal caregiver and advise on post- care options (prevention, advice, information and post-treatment);
– through information transfer and multidisciplinary care, contribute to a qualitative and efficient continuity of care for the stroke patient (integrated care).
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Shows How The students can:
– apply strategies and interventions if there are disorders and limitations in cognition, emotion and behavior;
– apply strategies and interventions if there are disorders and limitations in the field of communication (aphasia/dysarthria);
– prevent or reduce shoulder/hand problems;
– apply interventions in case of swallowing disorders;
– apply interventions in case of bladder/bowel problems;
– apply strategies and techniques if there are limitations in the field of ADL;
– interpreting and using transfer information from the acute phase for con- tinuation of the rehabilitation process;
– transfer information to after care for the quality and continuity of rehabili- tation/care;
– observe the ‘what/how/why’ observation methodology and report and interpret this data objectively;
– signal and use training opportunities in daily care in line with the multidis- ciplinary rehabilitation plan;
– identify limitations, objectives, and interventions and name them as part of the rehabilitation plan.
The students:
– work in a targeted manner towards the stroke-specific goals as stated in the multidisciplinary rehabilitation plan;
– contribute to a rehabilitation-supporting climate;
– contribute to a stroke-specific professional multidisciplinary team and pro- vide continuity of care (integrated care).
Does
The students:
– apply rehabilitative care in practice;
– act from the perspective of the patient and apply interventions that are feasible for a rehabilitative stroke patient;
– are able to negotiate with the rehabilitative stroke patient on a way in which the care/nursing component of the rehabilitation plan is completed;
– can move into the experience world of a rehabilitating stroke patient (shows empathy) and adjust the speed, communication and guidance based on this;
– can prepare, implement and adjust the care/nursing component of the mul- tidisciplinary rehabilitation plan.
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Core Competency 2: Cooperation
Nurses are able to effectively and efficiently work together with different profes- sionals in the integrated care service.
This core competence includes various types of cooperation. First of all, it involves peer cooperation in a multidisciplinary setting both inside and outside the organiza- tion the nurse herself is working in: the integrated care system. The objective of integrated care is to provide continuity of care and that one adjusts the care and treat- ment to the ever-changing health needs of the stroke patient during the various phases (acute phase, rehabilitation phase, chronic phase). Lastly, the cooperation with the families of the stroke patient is also included in this core competence.
Core Competency 2
Knows The students:
– know which disciplines are experts in the various problem areas of the stroke patient;
– know what integrated care is and what the importance is for the stroke patient;
– know that they themselves, and their own organization, are a link in the entire integrated care service;
– know common stroke-specific regional/national/international organiza- tions and information networks;
– know the impact of impairments and limitations as a result of stroke on the families of the stroke patient.
Knows How The students:
– know ways to access stroke-specific regional/national/international organi- zations and information networks;
– know how to involve different disciplines in the integrated care service;
– know how they can help the patient and his informal caregivers to cope with the consequences of stroke.
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Core Competency 3: Professionalism
The caretakers and nurses know (the limits of) their own expertise, work according to the most recent developments and standards related to stroke and use internal and external resources (Evidence Based Practice), so that optimal quality of care is provided.
Core Competency 3
Knows The students:
– know that there are national and regional stroke-specific protocols;
– know the importance of stoke-specific subject-related developments;
– know their own strong and weak (communication) skills in taking care of the patient and ask for help when necessary;
– are familiar with the relevant legal frameworks within which the rehabilita- tion care is given to stroke patients.
Does
The students:
– guard the self-reliance of the stroke patient in the overall care and encour- age cooperation of the patients and their informal caregivers in this;
– communicate in a professional manner with the stroke patient, his informal caregivers, colleagues from the multidisciplinary team and within the inte- grated care system;
– can professionally communicate with the stroke patient and his relatives;
– signal the need for coordination/management between professionals and put the questions and issues arise thereof, in the concerned organizations.
Shows How The students:
– identify the need to involve the various disciplines and take action in accor- dance with mutual and standardized agreements;
– make use of expertise of professionals in the integrated care service and information from stroke-specific organizations/networks.
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Knows How The students:
– know how access can be obtained to regional and national stroke-specific protocols;
– know how access can be obtained to stroke-specific subject-related developments;
– know how to test their own actions in regards to stroke-specific protocols and developments.
Shows How The students:
– A view to rehabilitation? Is that a better translation?
– show that they can work according to relevant stroke-specific protocols and professional standards and developments;
– find ways to further develop themselves.
Does
The students:
– integrate and implement the most recent developments, guidelines, proto- cols, and views in rehabilitation in daily practice;
– integrate their own expertise in the development of rehabilitation care in daily practice.