Professional competence: the construction of concepts, strategies developed by health services and implications for nursing

Abstracts

This study aimed to identify and analyze the scientific literature on the topic of professional competence, strategies of health institutions for its development and implications for nursing. It is an integrative review and search strategy was consultation with the electronic databases MEDLINE, LILACS and SciELO. Data collection was conducted between October and December 2010 and selected articles in Portuguese and English, a total of 23 publications. The thematic analysis of the data enabled the construction of three categories: The meanings of the concept of professional competence, Strategies for development professional competence and Implications for nursing. It was verified the predominance of the concept of professional competence from their constituent elements, knowledge, skills and attitudes, strategies and educational training programs for skills training and actions of management, and nursing, the challenge of train professionals competent and committed.

Professional competence; Health manpower; Health management; Managment

Este estudo teve como objetivo identificar e analisar a produção científica sobre a temática de competência profissional, as estratégias das instituições de saúde para o seu desenvolvimento e implicações para enfermagem. Trata-se de revisão integrativa e a estratégia de busca foi a consulta às bases eletrônicas MEDLINE, LILACS e SciELO. A coleta foi realizada entre os meses de outubro a dezembro de 2010 e os artigos selecionados estão em português e inglês, totalizando 23 publicações. A análise temática dos dados possibilitou a construção de três categorias: Os significados do conceito de competência profissional; Estratégias para desenvolver a competência profissional; e Implicações para a enfermagem. Constatou-se a predominância do conceito de competência profissional a partir de seus elementos constitutivos, ou seja, de conhecimentos, habilidades e atitudes; estratégias educacionais e programas de treinamento para a formação de competências como ações da gerência; e na enfermagem, o desafio de formar profissionais competentes e compromissados.

Competência profissional; Recursos humanos em saúde; Gestão em saúde; Gerência

LITERATURE REVIEWS

Silvia Helena Henriques Camelo^I; Emília Luigi Saporiti Angerami^II

^IPh.D. in Nursing. Professor of the Department of General and Specialized Nursing, University of São Paulo at Ribeirão Preto School of Nursing (EERP/USP). São Paulo, Brazil. E-mail: [e-mail]

^IIPh.D. in Nursing. Full professor (retired) Department of General and Specialized Nursing, EERP/USP. São Paulo, Brazil. E-mail: [e-mail]

Correspondence

ABSTRACT

This study aimed to identify and analyze scientific production regarding the theme of professional competence, the strategies used by health institutions for their own development and the implications for nursing. It is an integrative review and the search strategy used was an inquiry on the electronic databases of MEDLINE, LILACS and SciELO. Data collection was conducted between the months of October and December 2010, and the articles chosen are in Portuguese and English, totaling 23 publications. Thematic analysis of the data made it possible to build three categories: The meaning of the concept of professional competence; Strategies to develop professional competence; and Implications for nursing. A predominance of professional competence from its constituting elements was found; in other words, knowledge, abilities and attitudes; educational strategies and training programs for increasing competence such as management actions; and in nursing, the challenge of forming competent and committed professionals.

Descritores: Competência profissional. Recursos humanos em saúde. Gestão em saúde. Gerência.

RESUMEN

Este estúdio tuvo como objetivo identificar y analizar la literatura científica sobre el tema de la competencia profesional, las estratégias de las instituciones de salud para su desarrollo y sus implicaciones para la enfermería. Se trata de uma revisión integradora y estrategia de búsqueda se consulta con las bases de datos electrónicas MEDLINE, LILACS y SciELO. La recolección de datos se realizó entre octubre y diciembre de 2010 y los artículos seleccionados están em Portugués e Inglés, con un total de 23 publicaciones. El análisis temático de los datos permitió la construcción de tres categorías: Los significados del concepto de competencia profesional, Estrategias para desarrollar la competencia profesional y Implicaciones para la enfermería. Se verificó el predominio del concepto de competencia profesional de sus elementos constitutivos, es decir, conocimientos, habilidades y actitudes, estrategias y programas educativos de formación para la capacitación y acciones de gestión y de enfermería, el desafío de la formación de profesionales competentes y comprometidos.

Descritores: Profesional competência. Recursos humanos em salud. Gestión em salud. Gerencia.

INTRODUCTION

The transformations that have occurred in the modern world due to technological innovation and new forms of work organization, with a progressively more unstable and flexible market, demand the implementation of models for the education and management of the workforce based on professional competences.¹ In the health sector, as a consequence of these changes, institutions must constantly update their practices due to a requirement for workers with a unique profile and the necessary professional competence to fulfill a determined function or task, so that they can adapt to the new work demands.

The construction of professional competence is linked both to education acquisition and to informal learning processes that occur at different times and places. Saul Meghnagi,² a constructivist representative, has studied professional competence since the late 1980s and is a proponent of a research model conducted in the professional development field, where the term competence can be defined as the acquisition of appropriate skills for the execution of a task, or the ability to decide, using acquired skills and knowledge, to perform in a particular situation. It can also be described as an articulate and complex combination of skills and capabilities that result from a conceptual and functional synthesis of theoretical aspects, linked to disciplinary contents and current experience.^2-4 In this context, the worker's competence becomes an important ally for institutions and services, and it is for this reason that they seek professionals with advanced knowledge and behavioral qualities who are able to resolve problems.

The movement towards the adoption of competences, starting in the 1960s and already common in the United States and in Europe, arrives timidly in Brazil, having its beginnings in multinational companies in the 1980s. The first wave of competences was successfully set up as a systematized process in hiring selection by making it possible to verify an individual's ability to fit the profile of competences of a defined work position or function.⁴ In Brazilian universities, the concept of competence has only been discussed from the 1990s onwards, meaning that it is a tool that is only gradually materializing in the country.⁵

Currently, in a context in which demands have been rising related to productivity and quality of services and products, competence has been approached as the sum of the American and European lines of thought; in other words, ascribed to the results of a determined function or task and to the characteristics of the person's profile, which can help ease the development of competences for the organization.⁶ Professional competence is affected by the organization's environment, and it shows a level of sophistication that is dependent on objective reality and the subjective ability to analyze and influence the environment, with the possibility of developing itself in various ways and in different locations which are not necessarily the ones designated for its formation.⁴

In the health field, specifically in nursing, the Brazilian National Curriculum Guidelines define competences as fundamental aspects for the formation of pedagogical projects and curricular design of nursing courses, guiding the formation of professionals. From this perspective, instruction based on competences is indicated as one of the strategies for the transformations that have been occurring in the working world, especially in health services.⁷

Considering the reality of the health institutions, with the incorporation of new technologies and services, there is also the preoccupation with offering quality care that generates positive results, not only for the organization and its professionals but also to satisfy the clients' needs. Forming or mobilizing competences presupposes a type of specialized work inside the organizations, which must constantly search for instruments or strategies to develop them in order to help the professionals with their educational needs.

In this sense, the theme of professional competence has been the focus of many health workers, as well as of their managers, because in human resources lies a possible solution to the greatest questions of health care. Being capable of positively influencing changes in the life and health conditions of the population, they will manipulate the attention paid to health and therapy applied to individuals and collectivities.

Considering that the term professional competence is a concept in evidence, having different connotations and interpretations, the need to create environments in health institutions for the development of competence in professionals, in light of constant changes, and the health workers contingent (in nursing specifically) inside these organizations, competence presents itself as a guiding issue in this study: What are the concepts and meanings of the term professional competence? In the health sector, what are the strategies used by institutions to develop competence in their workers? Are there implications for health and nursing professionals?

The execution of this study will allow the understanding of the term professional competence, in addition to fostering reflection in health professionals and their managers regarding the relevance of mobilizing strategies to develop competences that contribute to the organization of work and excellence in provided services.

Accordingly, this study aimed to identify and analyze the scientific production surrounding the theme of professional competence, the health institutions' strategies for its development and the implications for nursing.

METHOD

In order to reach our objective, the integrative review method was chosen since it is the farthest-reaching methodological approach to revisions; it also allows the inclusion of experimental and non-experimental studies for a complete understanding of the analyzed phenomenon. It combines theoretical and empirical literature data, in addition to incorporating a vast amount of purposes: concept definition, theory revision and analysis of methodological problems of a particular topic.⁸

The research strategy was to conduct inquiries on the electronic databases of Medical Literature Analysis and Retrieval System Online (MEDLINE), Caribbean and Latin-America Literature on Health Sciences (LILACS) and Scientific Electronic Library Online (SciELO).

The following Health Science Descriptors were used for the bibliographical research: Professional Competence, Human Resources in Health and Health Management and Administration. The purpose of choosing broad descriptors was to gather the highest possible number of articles approaching the theme of "professional competence and management strategies", regarding health professionals in general, not merely a single professional category.

The adopted criteria for choosing the articles were: articles published in Portuguese, English and Spanish; in the last 11 years; available in full text; and approaching the explored theme. The time period chosen is related to the growing number of publications at the end of the 1990s, when the term professional competence became more widely discussed in Brazilian universities. It is also notable that during this period discussions began regarding the Brazilian National Curriculum Guidelines for the Health Field Courses, which guided changes in health education, based on competences.

The material chosen using the established criteria was analyzed according to its content, using the qualitative research methods.

RESULTS AND DISCUSSION

Characteristics of the studies

The bibliographical research was conducted between the months of October and December 2010, and the selected articles are in Portuguese and English, totaling 23 publications referring to the period from 1999 to 2010, as shown in ^{picture 1}.

Most of the selected articles are from national journals linked to public universities in the areas of nursing and business.

The keywords most frequently used by the authors were: competence, professional competence, human resources formation, competence-based education and management.

Analyzing the most frequent research methodologies in the articles, it was noticed that 18 articles used the qualitative methodological approach, three used the quantitative approach and two used a quali-quantitative approach. Among those that used the qualitative methodological approach, the methods utilized included: non-experimental descriptive, exploratory, hermeneutics and action-research. Regarding the quantitative studies, they are descriptive, prospective, cross-sectional, and case-control studies. The researches using the quali-quantitative methodological approach are descriptive and exploratory. In this sense, the analyzed research subject can be studied using different methodological outlines.

It is important to mention that among the selected studies, 13 articles focused on the theme of professional competence directed at nursing, which can be explained by the high number of workers in this area and by the constant concern regarding organization of their work by way of recycling and reviewing their practices, which has decisive repercussions on the health services offered to the population.

Thus, the thematic analysis of the selected articles revealed three categories: the meanings of the concept of professional competence; strategies to develop professional competence and implications for the nursing professional.

The meanings of the concept of professional competence

The term competence has undergone change. The reasons for this could be the organizational-technical changes that have occurred in the world of labor that have motivated new debates around the relationships among work, qualification and technological education.³⁰

Although it is possible to interpret competence in multiple ways, it is possible to notice the existence of two main theoretical views. The first one, represented mostly by North American authors,^31-32 views competence as a set of qualifications or characteristics fundamental to the person that allow them to perform a specific type of work or handle a given situation. The second, represented mostly by French authors, associates competence not to a set of personal attributes, but to whatever the individual produces or executes in their work.³³ Competence constitutes, therefore, a complex and multifaceted concept that can be analyzed under different perspectives, while being subject to ambiguity.¹⁸

In the Brazilian context, the approach to competence resulted in repercussions in the field of philosophy, economics, sociology, psychology and education, being discussed under different views and theoretical approaches. It also involves a common stance of critical, humanizing and emancipatory analytic perspectives.^2,34 When analyzing the literature it was noted that the construction of the meaning of professional competence was related to the individual's capacity to meet the organization's demands, contributing to the construction of organizational competences.³⁵

In this sense, researchers define professional competence as the gathering of specialized knowledge that forms the intellectual, technical-functional, behavioral, ethical and political competences, particularly by the professional in their productive role, in a way that generates recognized results individually or collectively.²⁴

Competence is considered to be an ability to make decisions in order to solve problems, perform your profession in different situations, fulfill your social role according to knowledge, experiences, values and attitudes,¹¹ and apply your knowledge within a specific context.²⁶ In other words, competence shouldn't be restricted to simple "know-how", lest it result in an automated and bureaucratic practice that excludes subjectivity, reflection and creativity from the one that conducts it.²⁹ Competence, on the contrary, should use habitual and judicious communication, knowledge, technical abilities, clinical reasoning, emotions, values and the capacity to reflect upon daily practice for the individual and collective benefit.¹⁰

When it comes to health professionals, these concepts must be accompanied by prospective analysis of the profession's practices in the context of technological innovations, changes in health services and the epidemiological profile, as well as the population's demographic pattern.¹⁵ In the context of these transformations, the definition of professional competence must favor the analysis of practices in health services and the reordering of the work/formation relationship, revealing new ways of educating professionals.

Professional competences can be expressed in three dimensions,³⁵ with the farthest achievement deemed essential competences, which express the organizational dimension of competence, representing survival of the organization. The essential competences must be fed and sheltered; they contribute as driving forces for the development of new enterprises.⁶

The second dimension refers to functional competences, also referred to as collective competences, which are associated with the mean-activities and the end-activities of the organization; in other words, they are the necessary competences for the specific functions of each area in a company, and they must be present in all members of each sector.³⁵ Finally, individual competences take into consideration the attitudes and behaviors compatible with the attributes that should be held by the professionals, for example: initiative, creativity, interpersonal abilities, verbal communication, leadership, entrepreneurship, empathy and others.⁵ In this category, management competences are of special notice, such as efficient communication, conflict negotiation and others, because they play a fundamental role in the activities linked to leadership. Considering the relevance of these competences for the organization of health services, we believe that there is a need to develop them in professionals. As one of the selected studies revealed, workers that were in management positions in health services often had a simplistic vision and were sometimes unprepared to take on their role.¹⁶

Regarding the elements or resources that make up professional competence, there are three common axes that are common among the authors: knowledge, understood as the professional's acquired knowledge; skills, such as the professional's specific know-how; and attitudes, also understood as "knowing how to do", to judge, to choose and to decide.²¹ Furthermore, professional competence must involve personal experiences and qualities used effectively and appropriately in individual and collective acts, as a response to the circumstances of the professional practice.²⁵ Thus, in order to act in a competent manner it is necessary to assume an active posture in face of work situations, as well as using and transforming knowledge with the aim to apply it in practice.²⁰ A competent professional is one who evidences quality in their performance and offers quality to the clients with whom they interact. Competent performance is the visible face of competence.¹²

It is important to stress that acquired competences such as knowledge and operating skills in a certain context take on a specific consistency in the close relationship among competence contents, use, control, elaboration and re-elaboration.⁹

Health care organization proposals demand the incorporation of the concept of professional competence, whose undertaking links education, work, formation, institutions, learning processes, resolve of the health care network and the population's quality of life.

Strategies to develop professional competence

The process of developing individual competences in organizations must happen in a specific professional context. It could be stated that the development of competences is related to the definition of organizational strategy. The organization, situated in an institutional environment, defines its strategy and the necessary competences to implement the strategy in a process of permanent learning.³⁶

In this sense, organizations search for new mechanisms to improve the capacity and speed of learning. Such mechanisms involve the development of educational systems and investment in training and development programs that play an important role in the formation of competences.¹⁹

The new world dynamic, characterized by the globalization of markets and rapid change, presents constant challenges for contemporary organizations. These transformations have been causing changes in businesses' administration, especially in managing the individuals who work in them, aiming to adapt to the market's demands.¹⁹

In the health field, particularly when it comes to professional formation, the building of competences requires the articulation of different types of knowledge for the construction of a new professional practice, based not only on the acquisition and incorporation of knowledge and abilities, but also on personal and relational attitudes that aim to construct a common project for the transformation of health's reality.¹⁷

The swift and constant changes that have occurred in the health labor market imply the importance of establishing a competence development program for health professionals working in this particular sector, by means of education at work, which allows for capacitation and continuing development of competences considered primary for their professional practice.

For the professional, capacitation represents the complete control of specific knowledge which is the result of formation, training and experience so that they can fulfill a determined function.¹⁴ The elaboration of learning strategies for the construction of competences in health professionals is a primary factor for services organization.

In one of the selected studies,²⁸ it was observed that during the construction and implementation of a competence development program for health professionals, explanations were given to the professionals related to the description of an activity containing information regarding the groups' constitution, guidelines, the context of the proposed initial problems, the group project's theoretical base, information flow, competences and expected results. The present study results revealed several professional competences developed by the groups, including the ability to commit and knowing how to take responsibility - a competence which is hard to develop in service, but was noted in the spontaneous attitudes and initiatives to take on roles and act when necessary. On the other hand, it requires from the institution a mobilization of resources and provision of operational conditions to support the work's development.²⁸

It should also be pointed out that other alternatives to broaden the professionals' vision of the workplace would be to encourage education by means of partnerships that promote their performance in the health field. Universities, as the main entities for the development of qualified professionals, are capable of creating environments where it is possible to develop competences. A permanent education program in the institutions can be prepared, with the aim of surpassing the practical-theoretical dominance demanded by the work market, transforming the subjects into innovative agents and reality transformers.²²

Permanent education, one of the necessary aspects of professional work, is characterized as having a multidiscipline target audience, focusing on institutionalized practice and health problems and aiming at the transformation of technical and social practices. It should be offered continuously using methodology centered on the resolution of problems and positive change as a result.³⁷

Implications for the nursing profession

In the current health sector context, the greatest challenge is the process of reorganization of health services when it comes to securing distribution and use of human, financial and material resources, which affect the efficiency and economy of the health system.

In the case of nursing, the professionals represent a significant share of the allocated human resources in health institutions, affecting the organization in a relevant manner. Nursing has the responsibility to provide care to the patient and, in order to do so, they need to have human resources at their disposal with command over this practice; in other words, with professional competence which allows them to perform their work aiming at efficient results.

Thus it is observed that one of the challenges that the nursing profession has been facing is the formation of professionals who are competent and committed to society and to its health problems, who seek to articulate theory and practice with a critical vision in relation to reality, integrating the different aspects of health problems, considering the complexity of the individual and the context in which they live and work.²³

The tendency in health care organizations is to search for competences that help the professionals in terms of their professional needs, especially regarding nurse care. The selected studies show concern with the development of a competent professional for work, highlighting the need for investment in the development of competences by the institutions.^11,14,23

Many competences appear to be necessary for the nurse in their professional practice; developing them is a great challenge, both for the institutions responsible for developing them and for the services, becoming the responsibility of all the participants: instructors, nurses in the services and the apprentices themselves.¹³ It is expected that a judicious selection of adequate professionals is established to guarantee equity and the completeness of care, bold objectives of the Brazilian Unified Health System).²⁷

Aiming for the formation of qualified professional nurses who are competent in their various work processes, we detect a need for the implementation of a capacitation program that contemplates the development of competence, also as a reinsertion strategy for the nurse in an institutional context.¹⁴

Also observed is the need for instruction to establish a closer relationship with the work market, in the sense of improving the value of management competences for nurses beyond the technical dimension, contemplating the communicative, ethical, political and developmental dimensions of citizenship.²²

CONCLUSIONS AND RECCOMENDATIONS

This study identified and analyzed, through an integrative review, national and international journals published between 1999 and 2010 in the areas of psychology, business and nursing that explored the theme of professional competence, organizations' strategies to mobilize competences in their workers and implications for health professionals, particularly nurses.

The predominance of the use of professional competence concepts created from their constitutive elements, in other words from knowledge, abilities and attitudes, was found. Professional competence involves experiences, attitudes and personal values used in a proper manner in response to various situations in professional practice. The most common researches were those attempting to identify relevant competences for certain occupational roles, such as that of the professional nurse, and the contribution of the learning processes implemented by the organizations (such as permanent education) toward the development of competences.

A preoccupation of institutions with the professionals' competence was observed. They are increasingly demanding qualified workers, with manual dexterity in addition to innovation, creativity and autonomy in decision-making. Professionals that are capable of handling rapid changes in the work market are in high demand.

In the case of nursing, the selected studies showed a preoccupation with the formation of a professional who is competent to handle the health needs of the population. In this sense, it is important to think about ways to make the instruction system more flexible, forming professionals with profiles that are adequate for the modern world and the demands of an uncertain future, capable of thinking creatively and easily able to face professional challenges.

Although of limited reach, this article presents contributions for the health and nursing fields, as it is a study about a theme that is in evidence and whose assumptions still require empirical investigation. In this sense, the importance of new research is stressed, research that can identify the workers' knowledge of a specialized function or specific assignment, thus favoring the continuous formation of these workers, reverberating in the process of work in health with the presence of subjects committed to the resolution of concrete problems in the population's health.

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Professional competence: the building of concepts and strategies developed by health services and implications for nursing

Competencia profesional: la construcción de conceptos, estrategias desarrolladas por los servicios de salud y las implicaciones para la enfermería

Publication Dates

• Publication in this collection
  24 June 2013
• Date of issue
  June 2013