Intellectual, Interpersonal and Technical Competencies

Intellectual Competencies

Intellectual competencies are discussed first because this is an invisible aspect of nursing that is very important for becoming a diagnostician. Intellectual skills include both knowledge of nursing diagnoses and the mental processes for use of knowledge. Nurses need to attain knowledge of diagnoses, their definitions and defining characteristics, especially those that are common to the populations with which they work, the interventions to treat the diagnoses, and the diagnostic processes that are used to interpret patient data. This knowledge is extensive and complex, so nurses should not be expected to memorize the available knowledge, but rather they need to know how to access the information that they need; the resources to obtain this knowledge should be available when needed.

Besides knowledge, thinking ability is the other important aspect of the intellectual domain. Even through, traditionally, thinking processes have not been emphasized in nursing, they are critical to use of nursing diagnoses. The cognitive skills of analyzing, logical reasoning, and applying standards are just thee of thinking processes that are needed for accurate diagnosis in nursing. These skills are developed, for example, through discussions of how data should be clustered to generate accurate diagnoses, the relation of data clusters to diagnoses, and comparisons of existing data to expected data based on research findings. Research findings in cognitive science and nursing show that adults at the same levels of education and experience vary greatly in thinking abilities (Lunney, 1992; Sternberg, 1997).

Research finding from cognitive science and other disciplines also show that thinking processes can be improved (Sternberg, 1997; Willingham, 2007). In Nursing, research studies have shown that critical thinking abilities vary widely and that critical thinking can be improved with education and effort (Tanner, 2006). This done through energy, focus, and support. To do this, students and nurses need to think about their thinking, referred to as metacognition (Pesut and Herman, 1992), by using the concepts of thinking that are relevant to nursing practice. A Delphi study of nurse experts in critical thinking (Scheffer and Rubenfeld, 2000) generated 7 cognitive skills and 10 habits of mind that were considered to be highly relevant to nursing practice. These 17 concepts of thinking should be used by nurses to think about their thinking. In any nursing situation, two or more cognitive skills are probably being used. The habits of mind support the cognitive skills. The combination of these critical thinking abilities that are needed for clinical situations are probably unique, so nurses need  to cultivate all of these critical thinking processes and not just focus on a few of them.

Critical thinking abilities are essential to achieve accurate interpretations of patient data and appropriate selection of interventions and outcomes, so developing high-level thinking abilities is a high priority. To do this, nurses and nursing students can:

§  Use thinking processes, rather than just receiving knowledge from others

§  When learning, think about the concepts, not just memorize knowledge

§  Seek support from others, e.g., teachers, other nurses, patients, to validate thinking processes

§  Develop confidence in ability to think.

Interpersonal Competencies

Nursing diagnoses are best used by nurses who have exquisite interpersonal communication skills. Such skills are needed so that patients will trust nurses enough to tell them about their responses to health problems and life processes. Trust is enhanced through a mature ability to communicate with others.

Nurses must assume that they do not know other people (Munhall, 1993). The only way other people can be known is through interpersonal processes, especially listening. Nurses who assume that they know patients without listening to them will not achieve diagnostic accuracy. They best use of nursing diagnoses is in partnership with patients and families. To work in partnership, nurses need to speak to people with respect and care, effectively listen, respect other people’s opinions and views, and know how to validate perceptions with patients and families. Learning these skills is challenge, so the interpersonal aspects of nursing need to be an integral part of learning to use nursing diagnoses.

Technical Competencies

Another baseline competency is the technical skill of conducting a nursing assessment. Obtaining valid and reliable data is the backbone of using nursing diagnoses, so nurses’ development of their ability to conduct comprehensive and focused health histories and physical examinations is essential. This technical skill is learned in courses on the topic and using nursing textbooks on health assessment. For example, the diagnosis and treatment of pain requires sophisticated assessment knowledge, including ways to explore the types and locations of pain, factors that make the pain worse or better, etc. The same is true of many of the diagnostic concepts such as body image disturbance.

An Assessment is a “nursing” assessment if it yields the data that are needed for nursing care. The assessment data that are generated by a biological systems review, which is done to yield medical diagnoses, are insufficient to yield the data needed for nursing diagnoses. Thus, other assessment frameworks such as the functional health patterns (Gordon, 2007) are being used in health care systems where the accuracy of nurses’ diagnoses is considered important. The functional health pattern framework is used later in this chapter to demonstrate how to generate nursing diagnoses from assessment data.