Just what do we mean when we talk about 'competent' perioperative practitioners? Just what do we mean when we talk about 'competent' perioperative practitioners?
Article Type: Viewpoint essay
Subject: Medical personnel (Practice)
Medical care (Quality management)
Medical care (Analysis)
Pub Date: 04/01/2012
Publication: Name: Journal of Perioperative Practice Publisher: Association for Perioperative Practice Audience: Academic Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2012 Association for Perioperative Practice ISSN: 1750-4589
Issue: Date: April, 2012 Source Volume: 22 Source Issue: 4
Topic: Event Code: 200 Management dynamics
Product: Product Code: 8010000 Medical Personnel NAICS Code: 62 Health Care and Social Assistance
Geographic: Geographic Scope: Australia Geographic Code: 8AUST Australia
Accession Number: 293545448
Full Text: Introduction

It is trite but true - competent practitioners are fundamental for safe and effective healthcare and we recognise 'competent' practitioners when we see them; likewise, we readily note incompetence. But what is 'competence' and how do we develop it in individuals and teams? These are not idle questions nor are they easily answered. Perioperative competence is an eclectic concept that has been difficult to define and even more difficult to measure. While perioperative competency standards are utilised in some countries to guide professional behaviours and practice, including practitioner assessment, agreement about what signifies competence is absent (Gillespie et al 2009). Competency is usually described in relation to standards of practice with little emphasis placed on its interpersonal aspects (Gillespie & Hamlin 2009). Yet there is a significant and growing body of knowledge that links adverse events to lack of appropriate interpersonal or non-technical skills (AIHW 2007), skills that are not necessarily taught or assessed. This presents a dilemma not only for individual perioperative practitioners, but also for managers, educators and regulators of the perioperative profession.


Many countries embraced the competency movement over the last two decades or so, and in the ensuing period of time the requirement that healthcare professionals be competent and accountable has been, and continues to be articulated (Gillespie & Hamlin 2009).

Nursing was in the vanguard in developing competency standards for practice, initially to underpin undergraduate curricula. Following on from the articulation of competency standards for beginning registered nurses, specialty competencies were developed for perioperative practitioners (amongst many).

However, these are based on expert opinion rather than empirical evidence (Davies & Hamlin 2003) and are open to interpretation (Gillespie et al 2012). Even the meaning of competence itself is unclear, having several definitions. Unfortunately, there are nurses and operating department practitioners (ODP) who have never heard of perioperative competency standards (Hamlin 2006), and many more who have, but who are confused about 'competence' - not only are competency standards difficult to translate into behaviours of practice (Pearson et al 2002), they do not necessarily reflect practitioners' experience of 'the real world' of the operating department (OD). Unsurprising, given that practice is dynamic and evolving, and this is not always reflected in competency standards, which tend to be static. Small wonder that practitioners are confused! Meantime, while the debate over definition continues, perioperative practitioners, educators and managers have to get on with the job of educating, assessing and evaluating performance and determining individual's 'competence' (or otherwise). Further, many professional regulatory bodies rely on self-assessment of competence for ongoing registration. How can this paradox be resolved?

Identifying and assessing competence

A starting point for addressing this dilemma about 'competence' could include a review of the literature and one such review, published in 2009, identified that specialised knowledge in the form of technical proficiency was important, but this was no longer the only indicator of perioperative competence. The other broad domain identified was the increased awareness and emphasis given to human factors - recognition that teamwork, communication, coordination and leadership also affect human performance (Gillespie & Hamlin 2009). Concurrent with identifying the meaning of competence in the OD as found in the literature, was the development of a self-assessment of competence tool, which arose out of previous research about the role of the perioperative nurse conducted in Australian operating suites (Gillespie et al 2010). Such tools are being developed elsewhere, in other areas of nursing specialisation (Cowan et al 2008).

Subsequent research including a national survey resulted in further development and validation of the Revised Perceived

Perioperative Competence Scale (PPCS-R). This is a psychometrically tested, sound, self-assessment tool that measure nurses' perceived competence (Gillespie et al 2012). There are several uses for a tool of this nature.

* As a self-assessment tool, the PPCS-R may be used for reflection to assist perioperative practitioners identify areas of strength and limitations, and to do so with confidence.

* Self-assessment provides a foundation on which to base the identification, development and implementation of pertinent continuing competence activities.

* The PPCS-R may be used to augment perioperative practitioners' annual performance review, and to assist OD managers and educators to strategise education initiatives, to meet the needs of the staff profile.

It will be necessary for further testing of the tool in different samples of perioperative practitioners, to enable cross-cultural comparisons. There are plans for this to occur in cohorts of Swedish and Scottish perioperative nurses (Gillespie et al 2012).


Meaningful self-assessment of performance depends upon the accurate measurement of underlying cognitive and affective qualities and skills. Despite the challenges in conceptualising and measuring the eclectic concept of competence, the results to date indicate that the PPCS-R captures the latent domains of perceived competence in the perioperative milieu. The PPCS-R is a cost-effective tool that may be used by nurses, ODPs and their managers to assess the level of perceived perioperative competence, and offers individuals the opportunity to garner important insights into performance through reflection. It is acknowledged that perceived competence is dynamic and situationally dependent, and thus its assessment is iterative and should extend across ODP and perioperative nurses' careers.

All that said there is much work yet to be done if we are to improve the care and safety of surgical patients and the development of this tool is but a small step on that journey.

* Lois Hamlin

Former Senior Lecturer, Director, Postgraduate Programs, University of Technology, Sydney, Australia

Thoughts and reflections on issues of interest to perioperative practitioners


Australian Institute of Health and Welfare and the Australian Commission on Safety and Quality in Health Care 2007 Sentinel events in Australian public hospitals 2004-05 [online] Available from: www.aihw.gov.au/publications/index.cfm/title/10353 [Accessed February 2012]

Cowan DT, Wilson-Barnet J, Norman IJ, Murrells T 2008 Measuring nursing competence: Development of a self-assessment tool for general nurses across Europe International Journal of Nursing Studies 45 (6) 902-913

Davies M, Hamlin L 2003 ACORN Competency Standards for perioperative nurses: Genesis, development and outcomes ACORN Journal 17 (3) 27-31

Gillespie BM, Chaboyer W, Wallis M 2010 Sampling from one nursing specialty group using two different approaches Journal of Advanced Perioperative Care 4 (2) 81-85

Gillespie BM, Chaboyer W, Wallis M, Chang A, Werder H 2009 Operating theatre nurses' perceptions of competence: A focus group study Journal of Advanced Nursing 65 (5) 1019-1028

Gillespie BG, Hamlin L 2009 A synthesis on the literature on competence as it applies to perioperative nursing AORN Journal 90 (2) 245-258

Gillespie BM, Polit DF, Hamlin L, Chaboyer W 2012 Developing a model of competency for the OR: Psychometric validation of the Perceived Perioperative Competence Scale-Revised International Journal of Nursing Studies 49 (1) 90-101

Hamlin L 2006 Setting the standard: The role of the Australian College of Operating Room Nurses Unpublished doctoral thesis, University of Technology Sydney

Thoughts and reflections on issues of interest to perioperative practitioners

Pearson A, FitzGerald M, Walsh K 2002 Nurses' views on competency indicators for Australian nursing Collegian 9(1) 36-40
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