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TUNING

GuidelinesandReferencePointsfor

theDesignandDeliveryofDegreeProgrammesin

Nursing

Edition2018

(14thOctober2017version)

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TuningEducationalStructuresinEurope

ThenameTuningwaschosenfortheprojecttoreflecttheideathatuniversitiesdonotlookforuniformityintheirdegreeprogrammesoranysortofunified,prescriptiveordefinitiveEuropeancurriculabutsimplyforpointsofreference,convergenceandcommonunderstanding.TheprotectionoftherichdiversityofEuropeaneducationhasbeenparamountintheTuningProjectfromtheverystartandtheprojectinnowayseekstorestricttheindependenceofacademicandsubjectspecificspecialists,orunderminelocalandnationalacademicauthority.

ThiseditionoftheTuningGuidelinesandReferencePointsforNursingispublishedintheframeworkoftheCALOHEEProject2016-2018(Agreementnumber2015-2666/001-001)ThisprojecthasbeenfundedwithsupportfromtheEuropeanCommission.Thispublicationreflectstheviewsonlyoftheauthor,andtheCommissioncannotbeheldresponsibleforanyusewhichmaybemadeoftheinformationcontainedtherein.FormoreinformationabouttheCALOHEEproject:CALOHEEwebsite:https://www.calohee.eu©CALOHEEProject2018AlthoughallmaterialthathasbeendevelopedaspartoftheTuningandCALOHEEProjectisownedbyitsformalparticipants,otherHigherEducationInstitutionsarefreetotestandusethematerialafterpublication,providedthatthesourceisacknowledged.Nopartofthispublication,includingthecoverdesign,maybereproduced,storedortransmittedinanyformorbyanymeans,whetherelectronical,chemical,mechanical,optical,byrecordingorphotocopying,withoutpermissionofthepublisher.

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GuidelinesandReferencePointsfortheDesignandDeliveryofDegreeProgrammesinNursing

CONTENT

1. Introduction

2. TheTuning-CALOHEENursingSubjectAreaGroup(2016-2017) InnerCircle OuterCircle3. Nursing:IntroductiontotheSubjectArea

3.1. Backgroundandcontext3.2. TrendsandConcerns

4. TypicalNursingDegreeProfile(s)andOccupations

4.1.Introduction4.2.Roleofthesubjectareainotherdegreeprogrammes

5. CompetencyprofilesandCompetences5.1. Competencyprofiles5.2. Subject-specificcompetences5.3. CivicCompetences

6. LeveldescriptorsforNursing

6.1. Introduction6.2. TheCALOHEEFrameworkofGeneralDescriptorsforNursing

7. Teaching,Learning,andAssessment7.1. Pedagogy7.2. QualityEnhancement

8. Somereflectionsonthepostgraduatecycles

8.1. Thirdcycleeducation8.2. Trendsandconcerns

9. Stakeholders,usefulcontactsandreferencesAppendixes1. 2017versionofBachelorsspecificnursingcompetences2. 2017versionofMastersspecificnursingcompetences3. RelevantChangesfromDirective2005/36/ECto2013/55/EC(itemsinbold)4. Appendix5:ListofthefirstSubjectAreaGroupforNursing(SAG1)Contacts

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1. Introduction

Tuning Guidelines and Reference Points 2018 for the Design and Delivery of DegreeProgrammesinNursingisaneweditionofadocumentpublishedin2011.Preparedbyan internationalgroupofacademicsandvalidatedby independent internationalpeers,this publication has proven its importance as a primary source of information and astimulusforreflectionamongstakeholders.

Anupdateisnownecessary:boththesubjectareaandsocietyhavechangedconsiderablyin recent years. Since this brochure serves as an international reference point for anacademic discipline in the European Higher Education Area (EHEA) framework, it isessentialthatitrepresentsthecurrentstateofaffairs.TheseGuidelinesnowconcernsnotonlydegreeprofilesandthetasksandsocietalrolesgraduateswilltakeon,butalsohowdifferentdegreesfitintothewidercontextofoverarchingqualificationsframeworks.Inotherwords,whicharetheessentialelementsthatconstituteaparticularsubjectareainhighereducation?Amongotheraspects,theseGuidelinesincludegeneraldescriptorsforthefirstandthesecondcycle,thebachelorandmaster,presentedineasy-to-readtables,andaremeant tobeusedasreferencepoints for thedesignanddeliveryof individualdegreeprogrammes.AccordingtotheTuningphilosophy,eachdegreeprogrammehasitsownuniqueprofile,basedon themissionof the institutionand taking intoaccount itssocial-culturalsetting,itsstudentbody,andthestrengthsofitsacademicstaff.

TheGuidelinesandReferencePointsaretheoutcomeofalongandintensecollaboration,startingin2001,inconjunctionwiththeearlyphasesoftheBolognaProcess,whichhasnow come to include 48 European countries. They are a result of the grassrootsuniversity-driven initiative called Tuning Educational Structures in Europe, or simply‘Tuning’,thataimstoofferauniversallyusefulapproachtothemodernisationofhighereducation at the level of institutions and subject areas. The Tuning initiative hasdeveloped a methodology to (re-) design, develop, implement and evaluate studyprogrammesforeachoftheBolognacycles.Validatedin2007-2008byalargegroupofrespectedacademicsfromnumerousacademicsectorsitstillstands.

TheTuningmethodologyisbasedonthestudent-centredandactivelearningapproachesithaspromotedsinceitsverylaunch.Tuning’smissionistoofferaplatformfordebateandreflectionwhichleadstohighereducationmodelsabletoensurethatgraduatesarewell prepared for their societal role, both in terms of employability and as citizens.Graduatesneedtohaveobtainedastheoutcomeoftheirlearningprocesstheoptimumsetofcompetencesrequiredtoexecutetheirfuturetasksandtakeontheirexpectedroles.Aspartoftheireducationgraduatesshouldhavedevelopedlevelsofcriticalthinkingandawarenessthatfostercivic,socialandculturalengagement.

UsingtheTuningreferencepointsmakesstudyprogrammescomparable,compatibleandtransparent. They are expressed in terms of learning outcomes and competences.Learningoutcomesarestatementsofwhatalearnerisexpectedtoknow,understandandbeabletodemonstrateaftercompletionofalearningexperience.AccordingtoTuning,learningoutcomesareexpressedintermsofthelevelofcompetencetobeobtainedbythelearner.Competencesrepresentadynamiccombinationofcognitiveandmeta-cognitiveskills,knowledgeandunderstanding,interpersonal,intellectualandpracticalskills,andethicalvalues.Fosteringthesecompetencesistheobjectofalleducationalprogrammes.Competencesaredevelopedinallcourseunitsandassessedatmanydifferentstagesofaprogramme. Some competences are subject-area related (specific to a subject area),others are generic (relevant formanyor all in degreeprogrammes).According to the

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Tuning philosophy, subject specific competences and generic competences or generalacademic skills should be developed together. Normally competence developmentproceedsinanintegratedandcyclicalmannerthroughoutaprogramme.

Theinitialcorecompetencesofthesubjectareawereidentifiedinaconsultationprocessinvolving four stakeholder groups - academics, graduates, students and employers -during the period 2001-2008. Since then similar consultation processes have beenorganisedinmanyotherpartsoftheworld:thesehavebeentakenintoconsiderationindeveloping thisnewedition.Thiseditionhasbeenelaboratedaspartof theCALOHEEproject (Measuring and Comparing Achievements of Learning Outcomes in HigherEducationinEurope),co-financedandstronglysupportedbytheEuropeanCommissionaspartofitsActionProgrammesforHigherEducation.CALOHEEprojectaimstodevelopaninfrastructurewhichallowsforcomparingandmeasuringlearningina(trans)nationalperspective.Besidesupdatingandenhancingthereferencepointsbrochuresithasalsodeveloped Assessment Frameworks which offer even more detailed descriptors thanthosepresentedinthisdocument.TheAssessmentFrameworksarepublishedseparately.

To make levels of learning measurable, comparable and compatible across Europeacademics from the single subject areas have developed cycle (level) descriptorsexpressed in terms of learning outcomes statements. In this edition, for the first timethesearerelatedone-to-onetothetwooverarchingEuropeanqualificationsframeworks,the ‘Bologna’ Qualifications Framework for the EHEA (QF for the EHEA) and the EUEuropeanQualificationsFrameworkforLifelongLearning(EQFforLLL).IntheCALOHEEprojectthesetwometa-frameworkshavebeenmergedintoonemodeltocombine ‘thebestoftwoworlds’.WhiletheEQFforLLLisfocusedontheapplicationofknowledgeandskillsinsociety,thefocusoftheQFfortheEHEAismorerelatedtothelearningprocessitself: it applies descriptors which cover different areas or ‘dimensions’ of learning:knowledgeandunderstanding,applicationofknowledgeandunderstandinginrelationtoproblemsolving,makingjudgments,communicatinginformationandconclusions,andfinally,knowinghowtolearn.

In developing the CALOHEE Tuning model, we realised that ‘dimensions’ are anindispensabletool,becausetheymakeitpossibletodistinguishtheprincipalaspectsthatconstitute the subject area. Dimensions help give structure to a particular sector orsubjectareaandalsomakeitsbasiccharacteristicsmoretransparent.Furthermore,the‘dimensionapproach’ is complementary to thecategories included in theEQF forLLL,which uses the categories of knowledge, skills and competences to structure itsdescriptors. Thus, in CALOHEE terms, the three columns correspond to a ‘knowledgeframework’,a‘skillsframework’anda‘competencyframework’,linkedbylevel.Thelastcolumn,the‘competencyframework’,referstothewiderworldofworkandsocietyandidentifies thecompetencesrequiredtooperatesuccessfully intheworkplaceandasacitizen.Itbuildsonthefirsttwoelements:knowledgeandunderstandingandtheskillsnecessarytodevelopandapplythisknowledge.

In addition to addressing cycle-level descriptors, Tuning has given attention to theEurope-wide use of the student workload based European Credit Transfer andAccumulation System (ECTS) to ensure the feasibility of student-centred degreeprogrammes.Sometenyearsagoittransformedtheoriginalcredittransfersystemintoatransfer andaccumulation system.According toTuning,ECTSnotonly allows studentmobilityacrossEuropeandinothercountriesaswell; itcanalsofacilitateprogrammedesignanddevelopment,particularlywithrespecttocoordinatingandrationalisingthe

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demandsmadeonstudentsbyconcurrentcourseunits.Inotherwords,ECTSpermitsustoplanhowbest touse students' time toachieve theaimsof theeducationalprocess,ratherthanconsideringteachers' timeastheprimaryconstraintandstudents' timeasbasicallylimitless.

Theuseofthelearningoutcomesandcompetencesapproachimplieschangesregardingthe teaching, learningandassessmentmethods.Tuninghas identifiedapproachesandbestpracticestoformthekeygenericandsubjectspecificcompetences.Someexamplesofgoodpracticeareincludedinthisbrochure.MoredetailedexamplescanbefoundinthesubjectareabasedAssessmentFrameworks.

Finally,Tuninghasdrawnattentiontotheroleofqualityintheprocessof(re-)designing,developing and implementing study programmes. It has developed an approach forquality enhancement which involves all elements of the learning chain. It has alsodevelopedanumberof tools and identified examplesof goodpracticewhich canhelpinstitutionstoimprovethequalityoftheirdegreeprogrammes.

This brochure reflects the outcomes of the work done by the Subject Area Group (SAG) in Nursing which was established in the context of the CALOHEE project. This SAG has built on the work of the SAG or SAGs that produced the previous editions of the brochure, as well as the work established by the European History Networks, CLIOHWORLD. The names of the members of the previous SAGs appear in chapter 2. The outcomes are presented in a template to facilitate readability and rapid comparison across the subject areas. The summary aims to provide, in a very succinct manner, the basic elements for a quick introduction into the subject area. It shows in synthesis the consensus reached by a subject area group after intense and lively discussions in the group. The more ample documents on which the template is based are also included in the brochure. They give a more detailed overview of the SAG’s conclusions.

We hope that this publication will be of interest to many, and look forward to receiving comments and suggestions from the stakeholders, in view of further improvement.

The Tuning-CALOHEE Management Team

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2. TheTuning-CALOHEENursingSubjectAreaGroup(2016-2017) Theworkinggroupisco-ordinatedbyMaryGobbiandMarjaKaunonen,whohaveeditedthebrochure.TheCALOHEESAGmemberslistedbelowhaveallcontributedtotheconstructionofthisbrochure.Co-coordinatorsFinlandMarjaKaunonenSchoolofHealthSciencesFacultyofSocialSciencesUniversityofTampere–Tamperemarja.kaunonen@uta.fi

UnitedKingdomMaryGobbiFacultyofHealthSciencesUniversityofSouthampton–Southamptonmog1@soton.ac.uk

InnerCircleBelgiumKatharineMeierArtesisPlantijnHogeschoolAntwerpen-Antwerpenkate.meier@ap.be

DenmarkBirteØstergaard/DortheNielsenUniversityofSouthernDenmarkboestergaard@health.sdu.dkDorthe.Nielsen@rsyd.dk

GermanyIngridKollakAliceSalomonUniversityofAppliedSciences-BerlinKollak@asfh-berlin.de

HungarySandorHollosSemmelweisUniversityFacultyofHealthSciences-Budapestholloss@se-etk.hu

IrelandAnnDonohoeUniversityCollegeDublin-Dublinann.donohoe@ucd.ie

ItalyAnnaMarchetti/AlessandroStievanoCentreofExcellenceforNursingScholarshipofIpasvi-Romeanna-marchetti@virgilio.itastievano@tiscali.it

LithuaniaJovitaDemskyteLithuanianUniversityofHealthSciencesjovita.demskyte@gmail.com

MaltaRobertaSammut/MariaCassarFacultyofHealthSciencesUniversityofMaltaroberta.sammut@um.edu.mtmaria.cassar@um.edu.mt

TheNetherlandsMaartenM.KaaijkSchoolofNursingHanzeUniversityGroningenUniversityofAppliedSciencesm.m.kaaijk@pl.hanze.nl

SloveniaMancaPajnič/LjubisaPađenFacultyofHealthSciencesUniversityofLjubljanamanca.pajnic@zf.uni-lj.siljubisa.paden@zf.uni-lj.si

SpainM.TeresaIcartIsernFacultyofMedicineandHealthSciences.SchoolofNursingUniversityofBarcelonamticart@ub.edu

UnitedKingdomLouiseBarriballFlorenceNightingaleFacultyofNursing&MidwiferyKing’sCollegeLondonLouise.barriball@kcl.ac.uk

EUEuropeanStudents’UnionIanMcCready

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OuterCircleHungaryLaszloPappUniversityofSzeged

IrelandMaryKellyDublinCityUniversity

IrelandTomO'ConnorRoyalCollegeofSurgeonsinIreland

ItalyUniversityofBologna(Riminicampus)GianandreaPasquinelli

ItalyMichelaZanettiUniversityofTrieste

PolandAgnieszkaGniadekJagellonianUniversityKrakow

RomaniaDanM.IliescuOvidiusUniversityofConstanta

SwitzerlandNathalieJanzUniversityofLausanne

TurkeyEvsenNazikCukurovaUniversity

UnitedKingdomAnnMacfadyenNorthumbriaUniversity

WeacknowledgetheconsiderableworkundertakenbyourTuningnursingpredecessorsingeneratingthefirsteditionofthebrochure.TheirnamesareacknowledgedinAppendix4.

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3. IntroductiontotheSubjectArea3.1 Backgroundandcontext

As discussed in the introduction, one crucial plank of the Tuning project is theidentificationofpointsofreferenceforgenericandsubjectspecificcompetencesatfirst,secondandthirdcyclegraduatesintheirrespectivedisciplines.NursingjoinedtheTuningproject in 2003 as the first ‘harmonised’ healthcare regulated discipline to apply themethodology. In thisbooklet,wepresent therevisedsecondeditionmaterial fromtheTuningdocumentsproducedbytheSecondNursingSubjectAreaGroup(SAG2).Sinceourlastpublishedwork,therehavebeensignificantdevelopmentswithinthefield,whichwenowoutline.

ThefirstTuningNursingSAG1(2003-2009)createdaplatformfordebate,lobbyingandreform within the EU professional space. During this period, the SAG1 developedcompetences for general nurses at the first cycle level (Bachelors level). Thesecompetencesweredesigned tobe compatiblewith the registration/licence topracticeassociatedwithwhatwasoriginallyknownasDirective77/452/EEC.ThisDirectivewassubsequently consolidated within the Directive 2005/36 on the recognition ofprofessionalqualificationsanditssubsequentamendments(seeAppendix3).TheTuningcompetences were used to inform national and local benchmarks for nursing (e.g.Denmark,UnitedKingdom,RepublicofIreland,Italy).Directive2005/35wasduetobeevaluated from2010/ 2011. In collaborationwith other key stakeholders, the TuningNursinggroupplayedasignificantroleinthefeedbackprocessesandrecommendationsfor the subsequent revision (see Gobbi, 2014). The new Directive (2013/55/EU)incorporatedsomeof theserecommendations,whichhavehadsignificant implicationsfornursingeducation,namely:

• Introductionofcompetences(seeAppendix3)• The capacity to use European Credit Transfer System (ECTS) to express the

theoreticalandclinicaltraininghoursrequirementfornursing(seeAppendix3)• TheopportunitytomakeamendmentstotheAnnexoftheDirectivetoupdatethe

currentcurriculumcontent.(Appendix3)• Languagerequirementsforthoseseekingmutualrecognitionunderthetermsof

theDirective.

Forfurtherdetailspleasesee-http://eur-lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A32013L0055

Unfortunately,atwo-tiertrackoptionforentrytonursingprogrammes(10and12yearsofgeneralschooleducationrespectively)wasalsointroducedandtheimplicationsofthishaveyettoberealised.ItwastimelythereforeforthenewNursingSAG2tocontinuetheworkoftheirpredecessorsandtoreviseandrefinethecompetencesinthelightoftheamendedDirectiveandthedevelopmentsincontemporaryhealthandpopulationneeds.Wesoughttoreviewtheextenttowhichthecompetenceswereamenabletoassessmentand responsive to the contemporary challenges and trends in the EU and externalenvironment, particularly with respect to global health, security, migration and theevolvingroleofnurses.

Nursingactivitycontinues tovaryacross theEuropeanspace in relation to theroleofregisterednursesinsociety,theorganisationofthehealthandwelfaresystems,thelegalauthorityandaccountabilityaffordedtonursesandtheavailablenationalresourcesofthe labourmarketandeconomy.Thescopeofregisterednursingpractice includes thefollowing spheres of responsibility: giving direct care, supervising others, leading,managing, teaching,undertakingresearchanddevelopinghealthpolicy forhealthcaresystems(ICN,2004).Noticeableadvancesinthenursingscopeofpracticeindicatedinthe

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first edition are now more prevalent. For example: nurse prescribing, telenursing,advanced,specialistandconsultantnurses.

The number of countries providing bachelors, first cycle nursing education forregistration continues to rise. Similarly, there has been a rise in post graduateprogrammesinnursingatsecondandthirdcyclelevels.Researchcapacityisstill initsinfancyinsomecountries,whileothersaregainingrespectabilityandstatuswithinthebroadermedicalandscientificdisciplines.Pioneeringandhighqualitynursingresearchhas established connections between nursing activity, level of education, workforceconditionsandpatientdependency,patientexperienceandoutcomes(seeGriffithsetal,2017;Balletal,2016;Dall’oraetal,2016;Aitken,etal.2014).Thesestudieshavedrawnattentiontotheimportanceofworkingconditionsforthewell-beingofbothpatients,staffandbyimplicationstudents.

The professional / academic literature continues to debate the topics concerning thenatureofnursing,nursingcompetence,nursingpedagogy,clinicallearninganddecisionmaking,andthestruggles forprofessionalizationwithinagroupthat ispredominantlyfemale in many countries. For the purposes of the Tuning project, the first cyclecompetences were designed for the contemporary professional, first level registerednurse. At the SAG1 meeting in Athens 2003, the Tuning group adopted a workingdefinitionoftheprofessionalfirstcycleregisterednurse,namely,

Thisregisterednurseisaprofessionalpersonachievingacompetentstandardofpractice at first cycle level following successful completion of an approvedacademic and practical course. The registered nurse is a safe, caring, andcompetent decision maker willing to accept personal and professionalaccountabilityforhis/heractionsandcontinuouslearning.Theregisterednursepractises within a statutory framework and code of ethics delivering nursingpractice (care) that is appropriately based on research, evidence and criticalthinkingthateffectivelyrespondstotheneedsofindividualclients(patients)anddiversepopulations.

Since2006,theTuninggrouphaveparticularlywelcomedthecollaborativesupportgivenby the European Federation of Nurses Associations, the European Council of NursingRegulators,theEuropeanFederationofNurseEducators,theEuropeanNurseDirectorsAssociation and the International Council of Nurses. These key collaborators wereinvolvedinthevalidationofthefirstNursingCompetencesin2007.TheyhavecontinuedtoworkstrategicallywiththeTuninggroupwithrespecttotherevisionstotheDirectiveandotherrelatednursingprojects.TheircontributionshavebeencrucialtothesuccessofthemovementtowardsacompetencebasedframeworkfornursingwithintheEU.

Inour first edition,wediscussedhow theadoptionof theECTS systemcouldaddresssome of the challenges posed by the variability of nurse education models. The newDirective2015/55/EU-whichnowrecognisesECTS-willenableagradualmovetobetteraligndevelopmentopportunities fornurses following their registration. However,wedrawparticularattentiontothefactthatthesubjectareaofnursingoperateswithinandbetween the ECVET (European Credit System for Vocational Education and Training,2005),ECTS,theEQFandDublinDescriptors.Thetwocreditbasedsystemsoperateindifferentways, thusmaking itdifficult fornurses trained in theECVETsystemtogainrecognitionintheHigherEducationsystemfortheirlearningachievements.Itiscrucialthat these different systems align to aid recognition and accreditation of differentcompetences and skills both theoretically and practically. Interestingly, the ECVETtechnicalspecificationidentifiesthe‘competentbodyresponsibleforthequalificationorits implementation’ as the body that ‘allocates the ECVET credit points to each unit[module] according to the relative volume, weight and level of knowledge, skills andcompetences to be acquired’. It is unclear therefore whether the ECVTS credits with

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respect to those programmes thatmeet the requirements of theEUDirective, are theresponsibilityofthevocationaltraininginstitution(e.g.ahospitaltrainingschool)orthenational competent authority. Likewise, because the scope of nursing practise withrespecttothenursedegreeofautonomyandauthorityvariesfromcountrytocountry,irrespective of their academic qualification, it is sometimes difficult to categorise anindividual’s achievements according to the descriptors or criteria of these differentQualification or Credit Frameworks. It is therefore crucial that work continues toharmonisetheseanomaliesandinteractionsattheEUleveltomakeexplicitthehorizontalandverticalachievementsofcompetenceswhetherclinicalortheoretical.

3.2. Trendsandchallenges

Theglobalfactorsinfluencinghealthcareandnursingareseenmostclearlyintherecentchallenges faced within the EU by terrorism, the rapid and global spread of someinfectious diseases, and the impact ofmigration due to disasters, conflict and relativepoverty(seeGobbi,2016).

Diversity:achallengeofthe21stcentury

Patientsandnurseshaveadiversesetofidentifies,someofwhichbecomerelevantinthehealth care context. This diversity has been conceptualized in nursing as ‘culturalcompetence’ in its broadest sense, “…the gradually developed capacity of nurses toprovide safe and quality healthcare to clients with different cultural backgrounds. …culturalbackground in this tentativedefinition isdeterminedbyvariants, suchasage,gender,race,ethnicity,religion,education,socioeconomicstatus,geographicregion,andoccupation[andability/disability,sexuality,healthbeliefs,…]1.

Thenursingprocess[assessing,(diagnosing),planning,implementing,evaluating]suggestthat the nurse should assess the patient, identifying needs, problems and contextualfactorsandworkwiththemtodevelopsolutions.Ideally, issuesaroundsocioeconomicstatusorlegalstatusinacountryshouldbeassessedaspartofthisprocess.Forexample,intheturbulentsocio-politicalcircumstancesinEuropeof2017-18peoplearemigratingin largenumbersaround theworld,both legallyandextra-legally (economicmigrants,refugees, asylumseekers).According tonationaland international law,migrantsofallkindshavevaryingaccesstotreatmentinthecountryinwhichtheyareseekingcare.

Professionalism in nursing requires not only knowledge and skills to implement thenursingprocessbutalsoattitudinalskillstoapplythenursingprocesstothepersoninfrontofthemataparticularmomentintime.However,thenurseisalsoanindividualwiththeirownsetofbeliefs,valuesandnormsworkinginalocalcontext.Thisinfluencestheircommunicationandinteraction,whichaffectstheoutcomesofcare.

Nursingeducationaddressesthese individualandsocialhindrancestonursingcarebydefiningtheprofessionalknowledge,skillsandattitudesrequiredtonursepatientsofallbackgrounds. Dimension 1 of the revised CALOHEE framework details three sub-dimensions of professional values and the role of the nurse; 1) practicing within thecontextofethicalandlegalcodes,2)acceptingresponsibilityforownprofessionalgrowthanddevelopmentand3)educating,facilitating,promoting,supportingandencouragingthehealthandwellbeingofpatients.Within this framework, nursing education provides a supportive yet challengingenvironmentforthestudenttodeveloptheskillsofself-reflectionandawareness.Thisenables students to identify their own social and personal hindrances to providing

1Cai,D.Y.(2016).Aconceptanalysisofculturalcompetence.InternationalJournalofNursingSciences,3(3),268-273.

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‘culturallycompetent’careandtodevelopstrategiestoaddresstheselimitations.Further,nursingeducation requires students to identify impedimentsdue to the structure andorganizationofhealthcareandtoengagewithapproachestoaddressthem.Thisaspectofprofessionalization isadvancedbynursingresearchers investigatingbothpracticeandeducation.

Anotheraspecttodeliveringculturallycompetentcareistheabilitytotestmodelsofcareand medical treatment to ascertain whether they are (a) culturally acceptable; (b)clinicallyeffective,and(c)requireculturaladaptationforacceptabilityandefficacy.Toaddressthesechallenges,nursesrequirecompetencesinconductingculturallyacceptableresearch/auditswithpatients,carersandtherapists.

AddressingthedemographicandhealthchallengesofEuropeinthecontextofthenursingworkforcerequiresamoreflexibleandsustainableworkforce,equippedtodealwiththechallengesofthe21stcentury.

SocialEntrepreneurship

An emerging area of importance is the role of nurses and nursing in socialentrepreneurship. In these situations they seek innovative ways to collaborate withpatients,communities,populationsandotherchangeagents to innovateandco-designsolutions to health careproblems. The skills sets for this include anunderstanding ofleading and managing change, principles of co-design, collaboration and financialmanagement. At themasters and doctoral level, these skills will become increasinglyimportantinthefuture.

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4. TypicalDegreeProfilesandOccupations

4.1 IntroductionThefirsteditiondiscussedhowthecountrymembershipofSAG1reflectedthevariousacademicandsocio-culturaldevelopmentalstagesofnursingandnurseeducationwithinthe European space. This remains the case in SAG2 where the outcome of a countryspecificsurvey(n=17)revealedasimilarsituation.Forexample,astudyoftheminimumacademic level specified by the relevant competent authorities –reveals: first cycleprogrammeswithregistration;programmesequivalenttotwothirdsorfiftypercentofafirst cycle programme; countries that have made the transition fromminimal highereducation association to first cycle; and situations where nurses acquire theirprofessional trainingat secondaryschool levelwithnohighereducationqualificationswithregistration.Insomecountries,academicnursingstillremainsembryonicandoftenunderthecontrolofmedical,scienceorhumanitiesFaculties.AmorerecenttrendisthedevelopmentofFacultiesofHealthSciences,inwhichprofessionslikenursing;midwiferyand allied health are co-located. One consequence of this trend is the facilitation ofinterprofessional education and the strengthening of these professions. However,occasionallythishasbeenattheexpenseofinteractionwithmedicalFaculties.TheSAG2survey revealed five research led universities, one specialised university, fourUniversitiesofAppliedSciencesandtengeneralcomprehensiveuniversities.

HigherEducationQualificationsatFirst,SecondorThirdcyclelevelsmaybeawardedinNursing Practice, Nursing Studies, Nursing Science or Humanities according to localcustom. This title assigned to an academic nursing degree is usually associated withwherethenursingdepartmentissituatedinthehighereducationinstitution.Wecontinuetouseourearlierdefinitions,wheretheuseoftheterm‘nursing’aloneisreservedforprogrammes where there are practice-based competences as a requirement of theprogramme award. To distinguish this type of degree from others, the term nursingscience is used interchangeably with the term nursing studies. The use of the word‘science’isnotmeanttoconveyacommitmenttoapositivistmodelfornursing;ratherthis reflects common usage of this term in many parts of Europe. It is important toacknowledgethatnursingisapractice-basedprofessionatalllevelsofitseducation.Inprogrammes where practice competences are a requirement of the award, then theclinicallearningexperienceandsupervisioniscrucialtothestudent’sdevelopment.Thisappliesequallytofirst,secondorthirdcyclestudies,whosetypologiesremainlargelythesameasin2008.

First,secondandthirdcycledegreesinnursingoftencomprisetwomaintypes,thosethatareassociatedwithprofessionalregistrationorthefurtherdevelopmentofpracticebasedcompetencesandthosethatarepurelytheoreticalinnature.Studentsenteringtheprofession who undertake first cycle degrees do so in the associated Faculty andpredominantlystudynursingitself.Inmanycountriesthereisarangeofprovision,andinsomecasespaucityofopportunities,fornurseeducation,particularlywithrespecttolifelong learning. Many countries remain unfamiliar with mechanisms for theaccreditation and recognition of prior learning and experience in nursing theory andpractice.Broadlyspeakingacademicqualificationsatfirstorsecondcycleforregisterednursesfallintosixcategoriesrepresentingthetypicalcurrentcareerroutesofnurses:

1. Leadership,managementandadministrationofhealthservices2. Practicefocusedcourses(e.g.Clinicalnursingspecialitiesandadvancednursing

practiceincludingpublichealthnursingandnursepractitioners)3. NursingScienceandresearch4. Researchmethodsinhealth.

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5. Nurseeducationandpedagogy6. Genericprogrammes

Someoftheseprogrammesarealsoassessedinclinicalpracticeandmayberegulatedatnationallevel–particularlyatsecondcycle,forexample,advancednursepractitioners.Somesubcyclecoursesmeetspecificlabourforceneeds(e.g.intensivecare)withsomebeingregulated-includingnurseandmidwifeprescribers.Thereisarapidlyexpandingprovisionatmasterslevelwithastrengtheningoftheclinicalnursingprogrammes.TheEuropeanSpecialistNursesOrganisationsgroup(ESNOseehttp://www.esno.org/)hasdeveloped frameworks for nursing specialisms. A feature of the new Directive is thefacility to develop Common Training Principles and Frameworks for specialistqualifications. Once approved, these common training frameworks would providevehiclesformobility.BothESNOandtheEuropeanSocietyofCardiologyareexploringthese issues with respect to the common training frameworks(http://www.escardio.org/Education). Hence, where the competences developed atmasters level inTuning2008were for generic nursing competences,wenowneed toaddressmasterslevelinnursingpractice.

Increasingly,registerednursesundertakearangeofinterprofessional/multidisciplinarycourseswith their health, social care and education colleagues, for example in healtheducation,communitystudies,rehabilitation,nutrition,publichealth,counselling,asthmaandelderly care. In somecountries, specialisationoccursasvocational training ratherthan university/higher education. In contrast, others are now developing ‘consultantnurses2’atprofessionaland/ordoctoral(thirdcyclelevel)withthesepractitionershavingbeenestablishedforadecadeinsomecountries.Barr(1998)outlinedthethreetypesofcompetencesinthecontextofhealthinterprofessionaleducation,namely:

• CommonCompetencesarethoseheldincommonbetweenallprofessions.

• ComplementaryCompetencesdistinguishoneprofessionandcomplementthosewhichdistinguishotherprofessions.

• Collaborative Dimensions of competence which every profession needs tocollaboratewithinitsownranks,withotherprofessions,withnon-professionals,withinorganisations,betweenorganisations,withpatientsandtheircarers,withvolunteersandwithcommunitygroups.

Withrespecttocoursecontent,Barrsuggeststhat

• Commoncontentiswhereprogrammeparticipantslearnthesamecontent.

• Comparativecontentiswhereparticipantslearnaboutoneanother.

• Mixedcontentcomprisesacombinationofbothcommonandcomparativecontent.

Takingthesefactorsintoaccount,interprofessionalprogrammesorcontentneedtomaketheabovecompetencesandcontentrequirementsexplicit.

There are two types of doctoral studies in nursing. The first is the traditionalempirical/theoreticalbaseddoctorate(PhD).Thesecondisthe‘professionalorclinical’doctorate. The latter is emerging in nursing (and other allied health professions) asnurseshavemoreacademic andprofessional opportunities tobecomemore specialistand can lead and advance practicemanaging a user case load as an independent andautonomous practitioner (see Section 7). With respect to employment after 3rd cycleeducation,itwasnoticedbySAG1,thatmostofthegraduatesareemployedbyacademic

2 Consultantnursesarepreparedataminimumofsecondcyclelevelandhavedemonstratedadvancedcompetencesinexpertclinicalpractice,leadership,researchandeducation.Mostarenowatthirdcyclelevel.

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faculties, either as educators, researchers or in joint appointments, e.g. 75% teachingcombinedwith 25% research.Doctorally qualified nurseswork in nursing colleges orpolytechnics as senior educators in vocational or professional education. Anotheropportunity isemploymentasa researcher ina research institute.Amorerecent,andwelcome phenomena, is the increasing numbers of doctorally prepared third cyclenursing graduates in the health sector. Thosewith a clinical doctoratemightwork asclinical specialists, nurse consultants or as clinical researchers in the area of theirexpertise.Thirdcyclegraduateshavealsofoundworkopportunitiesasmanagers,policymakersorhighrankingcivilservantsinthehealthorsocialcarefield.Insummary,thedepthandbreadthofthecompetencesetofnursesatdifferentstagesoftheirprofessionalandacademicdevelopmentissuchthattheyareveryemployable.Theyhaveopportunitiesnotonlywithinthefieldofdirectpatientcare,butalsointhebroaderhealthsystemandbeyondastheSAG2surveyconfirmed.Tables1and2outlinethetypicaldegreeprofilesatfirstandsecondcycle.

Table1.Firstcycleprofilesandoccupations

Firstcyclepreparationforregistration/licencefornonnurses

Firstcycleprogrammeincludingpracticalcompetencesforregisterednurses(nursingpractice)

Firstcycleprogrammewithoutpracticecompetencesforregisterednurses

Typicalnameofdegree

AccordingtoFacultytradition,BSc,BA,orBNin

Nursing,NursingStudiesorScience

MorerecentlyemergenceofHealthSciencedegrees.

AccordingtoFacultytradition,BSc,BA,orBNin

NursingorClinicalPractice.

AccordingtoFacultytradition,BSc,BA,orBNin

NursingStudiesNursingScienceNursingandHealthManagement(asfirstdegreeaftertheprofessionaldegreeinGermany)

Profileofstudies

Forgeneralnurses,thisprogrammewillensurerequirementsforEUDirective3havebeenmet-3yearsand4600hours.Specifiedcontentoftheoreticalandclinicalinstruction.

Requirementsforregistrationbycompetentauthoritywillhavebeenmet.

Academicstandardswillmeetnationalframeworks.

Somecountrieshavenationalstandards/

Studyprogrammeforregisterednursestogainafirstcycledegree.Usuallyinoneormoreofthefollowingareas:-Leadership,managementandadministrationofhealthservicesClinicalnursingspecialitiesandpublichealthGeneralnursingstudiesResearchmethodsinhealth.

Studyprogrammeforregisterednursestogainafirstcycledegree.Usuallyinoneormoreofthefollowingareas:-Leadership,managementandadministrationofhealthservicesClinicalnursingspecialitiesandpublichealthGeneralnursingstudiesResearchmethodsinhealth.

3 EU Directive 2005/36/EC and from 2016- 2013/55/EU

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competencesfornursingtheoryandpractice.

Mayhaveinterprofessionalormultidisciplinarycomponents

NurseeducationandpedagogyMayhaveinterprofessionalormultidisciplinarycomponentsInadditionastrongfocusonincreasingpracticebasedcompetences.

NurseeducationandpedagogyMayhaveinterprofessionalormultidisciplinarycomponents

ECTSrange 180-240

Majorityat180,butincreasinglyover4years.

Assessmentofpracticalcompetences

Yes Yes No

Mostrelevantcompetences-subjectspecific

Alldomainsarecrucial,butthereislessemphasisonleadership,managementandadministrationofhealthservicesandresearchskills.Nationalfocusaccordingtothehealthandeducationsystemsandhealthneedsofpopulation.

Focusonclinicalcompetencesandrelatedhumanitiesandsciencebasis.

Researchskillsinhealthandnursingpractice

Managementskills

Emphasisaccordingtothemainspecialityofthedegree.

Researchskillsinhealthandnursing.

Mostrelevantcompetences-generic

Applicationofknowledgetopractice.EthicalCommitment.

Applicationofknowledgetopractice.EthicalCommitment.

Applicationofknowledgetopractice.EthicalCommitment.

Occupationaldestinations

Registerednurseaccordingtocountrytraditioningovernmental,voluntary/non-governmentalandprivatesectorsandacademia.Accesstootheroccupationsrelatedtohealthandsocialcare(e.g.pharma,medicaldevices)Accesstootherpersoncentredoccupations(e.g.serviceindustries).

Table2.-Secondcycleprofilesandoccupations Secondcyclewithenhanced

clinical/practicecompetencesfornurses

Secondcycleforregisterednursesaccordingtoareaoffocus

Typicalnameofdegree

AccordingtoFacultytradition,MSc,MA,orMNinNursingorClinicalPractice.

AccordingtoFacultytradition,MSc,MA,orMNinNursing,NursingStudiesorScienceortopicareasnamedbelow

Profileofstudies

Studyprogrammeforregisterednursestogainasecondcycledegree.Usuallyinoneormoreofthefollowingareas:-

Studyprogrammeforregisterednursestogainasecondcycledegree.Usuallyinoneormoreofthefollowingareas:-Leadership,managementandadministrationofhealthservices

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Leadership,managementandadministrationofhealthservices

Clinicalnursingspecialities/publichealth

Advancednursingpractice/nursepractitioner

Generalnursingstudies

Theseprogrammesmayhaveinterprofessionalormultidisciplinarycomponents

Academicstandardswillmeetnationalframeworks.

Somecountrieshavenationalstandards/competencesfornursingtheoryandpractice.

Morespecialistknowledgerelatedtonursingpractice.

Inadditionastrongfocusonincreasingpracticebasedcompetences

Clinicalnursingspecialities/publichealth

Nursingscienceandresearch

Generalnursingstudies

Researchmethodsinhealth.

Nurseeducationandpedagogy

Mayhaveinterprofessionalormultidisciplinarycomponents

Academicstandardswillmeetnationalframeworks.

ECTS Rangeis90-120

Assessmentofpracticalcompetences

Yes No,althoughthiswilldependuponthespecialityandsubsequentoccupation.

Mostrelevantcompetences-subjectspecific

Focusonclinicalcompetencesandrelatedhumanitiesandsciencebasis.

DevelopmentofResearchskillsinhealthandnursingpractice.

Nationalfocusaccordinghealthandeducationsystemsandhealthneedsofpopulation.

Emphasisaccordingtothemainfocus/specialityofthedegreeoutlinedabove.

DevelopmentofResearchskillsinhealthandnursing.

Mostrelevantcompetences-generic

Emphasisaccordingtothemainfocus/specialityofthedegreeoutlinedabove.Analysis,problemsolving,developmentofresearch,auditand/orevidencebasedskills.Self-reflection.EthicalCommitment,LeadershipandTeamWorking.

Typicaloccupationaldestinations

Clinicalspecialityfocus-nursespecialist,clinicalnursingleadership,nurseteacherorlecturerofnurses.

Leadership/managementoradministrationfocus-NurseorhealthservicesmanagerEducationfocus-TeacherorlecturerofnursesResearch/auditmethods-Researchcareerinnursing.Academiccareerorbasedinhealthservicesforresearchoraudit.

Themajorityofthefirstcycleprogrammesnowhaveawindowforbothinternationalmobility,electivesorminoroptions.Duetotheregulatednatureoftheprogrammes,thecreditsassignedaremainlyunder20ECTScreditsalignedtotheprogrammeoutcomes.

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4.2 Roleofthesubjectareainotherdegreeprogrammes

Giventheregulatednatureoftheacademicandprofessionalprogrammesassociatedwithnursing,thesubjectareaitselfrarelycontributestootherdegreeprogrammes.Thisisnottosaythattheremaynotbesharedlearningandteachingwithotherhealth/socialcaredisciplines and professions. For example, there may be joint programmes to developindividuals as registered nurses and social workers. Similarly, registered nurses mayundertakemodules/unitsoftheirprogrammewithotherdisciplines,(e.g.pharmacology,ethics,research,sociology,publichealth, leadershipandmanagementorpsychologyofhealth), but the ‘pure’ nursing units are rarely undertaken as part of other degreeprogrammes.Interprofessionallearningisincreasingatallcycles,butspecificallyatfirstcycle pre-registration level is where competences are held in common with otherhealth/socialcarestudents.

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5. LevelDescriptors,LearningOutcomesandCompetences5.1 CompetencyprofilesTheoriginalleveldescriptorsfornursingtookintoaccounttheDublindescriptors(seewww.jointquality.org),thedescriptorsintheQualificationsFrameworkfortheEuropeanHigherEducationArea andother relevant (national) frameworks.Due to the evolvingstateofnursingpractice,educationandresearchinthemajorityofEuropeanCountries,theyhavebeenfurtherrefinedinSAG2.Thesecompetencesmustbeviewedinthecontextof the scopeofpracticeof thegeneralnursewithinagivencountry.Thecompetencesoutlinedlatershouldalsobeexpressedinthecontextofboththeleveldescriptorsandthenurse’sscopeofpractice.Theformatforoutliningtheleveldescriptorforthenurseisasfollows:

- SummaryCompetenceprofile- Goals of the competences- intellectual, professional and academic and where

appropriatethepracticalcompetences- Associatedformalrequirements:admissionrequirements,programmelengthand

furthereducationopportunities.

Beforeproceedingfurther,weneedtodefinesomeofthetermsthatwillbeusedwithinthe competences and learning outcomes descriptions. First, we define the concept offamily as referring to two ormore individualswhodepend on another for emotional,physicaland,economicsupport.Themembersofthefamilyareself-defined4Second,weshall refer to the person (s) receiving nursing care and practice as ‘patient’. This is apragmaticdecisiontoavoidalengthyarticulationofthevarioustermsthatcanrefertotheperson-forexamplechild,adult,client,patient,serviceuser.Henceforthepurposesofarticulation, the term ‘patient’ isused inan inclusivemanner to refer to theperson,irrespectiveofage,stateofhealth,illnessorcognitiveability,withwhomthenursewillinteract.Thetermpopulationwillrefertoitsepidemiologicaldefinitionand,withinthecontextofhealtheducationorhealthpromotion,thetermpersonwillbeapplied.CycleLevelDescriptors

FirstcycleleveldescriptorsCompetencyprofileforthequalificationwithregistrationA Bachelor in Nursing / Nursing Science will have achieved specified competencesacquired during a development-based study programme located in an academicenvironmentwithresearchaffiliation.Theprogrammewillincluderelevantmandatorytheoretical and practical components agreed in dialogue with stakeholders andcompetentauthorities.Thegraduateshouldpossessbasicknowledgeof,andinsightinto,thecentraldisciplines,researchprocessesandmethodologiesusedinthenursingprofession.Theseattributesshouldqualify thegraduate tocarryoutvocational functionsandtoact independentlywithintheareatargetedbythestudyprogramme.Thegraduateshouldbeequippedtoundertake further work/practice based learning and, where appropriate, for furtherstudyinarelevantprofessionalarea,secondorthirdcycleprogramme.

4 adapted from Kaakinen JR, Gedaly-Duff V, Coehlo DP, Hanson SMH. Family Health Care Nursing: Theory, Practice and Research. 4th ed. Philadelphia: F.A. Davis Company; 2010.

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CompetencygoalsABachelorinNursing/Nursingscienceisableto:Intellectualcompetences:

• describe,formulateandcommunicateprofession–relatedissuesandoptionsfortakingaction

• analyseprofession-orientedissuestheoreticallyandconsidertheminpractice• structureownlearning

Professionalandacademiccompetences• applyandevaluatedifferentmethodologiesanddisciplinesrelevanttonursing• demonstrateinsightintocentraltheories,methodologiesandconceptswithinthe

nursingprofession• document, analyse and evaluate the various approaches, tools or models of

nursingpractice• utilizeresearchanddevelopmenttodevelopevidence-basednursingandnursing

activitiesPracticalcompetences

• demonstrateproficiencyinthepracticalnursingcompetences/skillsrequiredfortheregistrationorlicence(seelistoffirstcyclecompetences)

• makeandjustifydecisionsbasedonhisorherownnursingexperience• show personal integrity and act within the framework of nursing ethics and

nationalscopeofpractice• demonstrateabilityandwillingnesstofunctioninamultidisciplinarysetting• participateandconductdevelopmentwork,auditsandprojects relevant to the

nursingprofessionFormalaspects

- Admittance- Should meet University requirements or equivalent (includesaptitudeforpersonbaseddisciplineandethicalcommitment-‘goodcharacter’andlanguagecompetence)

- ProgrammeLengthaminimumof180--240ECTScredits(werecommendthatfutureprogrammesshould includeaminimumof90creditsdesignated for thepractical competence and that the programme length should be at least 2405.Pleaseseesection‘StudentworkloadandECTScredits’.

- Furthereducationoptions: Second cycle /Master programmes, Professionaltheoreticalandpracticalprogrammes.Developmentasleader/manager,clinicalspecialist,educatororresearcher.

Secondcycleleveldescriptors

CompetencyprofileforthequalificationAMasterinNursingScience/Studiesgraduatewillhaveachievedcompetencesthathavebeenacquiredviaacourseofnursingstudiessituatedinaresearchenvironmentcontext.Thegraduateisqualifiedforemploymentinthelabourmarketonthebasisofhisorheracademicdiscipline(nursingscience),professionalcompetence(nursing)aswellasforfurtherresearch(doctoralstudies).Whencomparedtoafirstcyclegraduateinnursing/nursing science, the second cycle graduate will have developed his or her academicknowledgeandindependencesoastobeabletoapplyscientifictheoryandmethodonanindependentbasiswithinbothanacademicandprofessionalcontext.

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In the case of a candidate studying for a second cycle degree in clinical nursingwithassociated practice competences, then the person will be able to perform advancedand/orspecialistnursingactivitiesasdefinedbytheirscopeofpractice.AttheEuropeanlevel, the specific subject clinical/practical competences for the Master in Nursing(Practice)aretobedevelopedastheycurrentlyvaryfromonecountrytoanotherandreflect institutional options and the scope of practice for the nurse. We offer somesuggestionsandexamplesinthisdomain.CompetencygoalsInadditiontothecompetencesdescribedforthefirstcycle/Bachelor’sdegree,asecondcycle/MastersinNursing/NursingSciencegraduateisableto:Intellectualcompetences

• Communicatecomplexprofessionalandacademicissuesinnursingandnursingsciencetobothspecialistsandlaypeopleinaclearandunambiguousmanner

• Formulateandanalysecomplexscholarlyissuesinnursingandnursingscienceindependently,systematicallyandcriticallyintherelevantspecialisation

• Continueowncompetencydevelopmentandspecialisationinamannerthatmaybelargelyself-directedorautonomous

Professionalandacademic• Evaluatetheappropriatenessofvariousmethodsofanalysisandcomplexissues

in nursing and nursing science from an academic and advanced professionalnursingperspective

• Demonstrate:• specialistunderstandinginextensionoftheBachelordegree• abroaderacademicperspectiveforhisorherBachelordegree• newacademiccompetencesinadditiontohisorherBachelordegree

• Demonstratecomprehensiveunderstandingofresearchworkinnursingscienceandthereforebecapableofparticipatinginresearch.

Practicalcompetences• Makeandjustifydecisionsreflectingonsocialandethicalresponsibilitiesaswell

as nursing and nursing science issues and if necessary carry out analysis thatresultsinanadequatebasisfordecision-making

• Comprehend development work based on scholarly, theoretical and/orexperimentalmethodsinnursingandnursingscience

• Make and ensure that that clinical practice is based on relevant evidence andknowledge.

• Demonstrate ability to involve both patents and close relatives in care andtreatmentonadvancedlevel.

• Demonstratepracticalinsightintotheimplicationsandapplicationsofresearchand evidence based practice in a practice based profession (research ethics,governance,audit).

Formalaspects

• Admittance requirements: Selected first cycle degree programmes with asatisfactory performance or professional equivalent (for professional practiceprogrammes this includes aptitude for person based discipline and ethicalcommitmentandmayincludespecifiedprofessionalpracticeexperience).

• Length: 90 or 120ECTS credits (we recommend that future programmes thatfocus on advanced/specialist practice should assign designated credits for thepractical competence and that theprogramme length in this case shouldbe atleast120credits)

• Furthereducationoptions:Doctoralprogrammesorspecialistnursing.

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Thirdcycleleveldescriptors

CompetencyprofileAdoctoralstudiesgraduateinnursingsciencewillhaveachievedcompetencesacquiredthroughacourseofnursingstudiesbasedonempiricalwork.Thiswouldincludeoriginalresearch conducted on an independent basis. Within an international context, thegraduateisabletoconductresearch,developmentandteachingtasksatacademic,healthcaresettingsandotherorganisationswhereabroadanddetailedknowledgeofresearchinnursing science is required.Their researchwillhavebeenbasedonanappropriateresearchmethodin,orappliedto,nursingandthusyieldsaresearcheffortthatequalstheinternationalstandardfordoctoralstudies.

A clinically focused doctorate graduate will have conducted empirical work that iswork/practice focused and will have gained increased competences in work basedfunctions (see section 8). At the European level, the specific subject clinical/practicalcompetencesfortheDoctorateinNursing(Practice)aretobedevelopedastheycurrentlyvaryfromonecountrytoanotherandreflectinstitutionaloptionsandtherelatedscopeofpracticeforthenurse.CompetencygoalsIn addition to the competences described for the second cycle, a third cycle nursinggraduateisableto:Intellectualcompetences

• Communicate,anddefend,asubstantive,contemporaryanddetailedknowledgeofaspecificareaofnursingbothorallyandinwriting

• Formulate and structure a long-duration, continuous research project on anindependentbasis

A‘professional’doctorategraduatewouldbeableto:

• Communicate,anddefend,asubstantive,contemporaryanddetailedknowledgeofaspecificareaofnursingpracticebothorallyandinwritingto/withpeers,thelargerscholarlycommunityandwithsocietyingeneral

• Lead,formulateandstructurealong-duration,continuousworkbasedproject.• Achievedesignatedadvancedpracticecompetencesrelatedtotheirworkbased

functionProfessionalandacademic

• Conductnursingresearchonaninternationallevelandinaninternationalcontext• Initiate, formulate, structure, leadandevaluate the appropriatenessofnursing

sciencemethodsforresearchprojectsonanindependentbasis• Demonstrate specialist nursing science understanding of cutting-edge theories

andmethodsinnursingandrelatedsciencesataninternationallevel• Display responsibility in relation to own research (research ethics and

governance)A‘professional’doctorategraduateisableto:

• Conductnursingprojectsintheirfieldfullyawareoftheinternationalapplicationandrelevanceoftheproject.

• Evaluate the appropriateness of nursing science methods for clinically basedprojectsonanindependentbasis

• Demonstrate and promote specialist nursing knowledge and practice derivedfromcutting-edge theories andmethods innursing.This knowledge shouldbeadaptedforthesocialandculturalcontextofpractice.

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• Displayethicalandgovernanceresponsibilityinrelationtoownresearch/workbasedpractice(researchandpracticalethics)

Practicalcompetences• Plan andmaintain academic and professional responsibility for complex tasks

basedonscientificnursingtheoriesand/orskillsandmethodsofresearch• Makedecisionssupportedbycomplexdocumentation/clinicalevidence• Criticallyanalyse,evaluateandsynthesisenewandcomplexinformationthatis

relevantforprofessional/clinicalpractice,societyandpolicydevelopment• Developinnovativeapproachestonursingpracticethatarepatient/clientcentred

Formalaspects

• Admittance requirements: Selected second cycle degree programmes withsatisfactoryperformanceorprofessionalequivalence.(Forprofessionaldoctorateandpracticalcompetences,thisincludesaptitudeforpersonbaseddisciplineandethicalcommitmentandmayincluderequirementsforprofessionalexperience).

• Length:180ECTS-240*ECTScreditstoincludeprofessionalcompetenceswherethis isanoption. In somecountries the lengthof theprogrammehasnotbeenspecifiedintermsofcredits.

• Further education options: No degree-conferring further education options.Membershipoflearnedsocietiesandprofessionalassociations.

5.2 GenericCompetencesInthefirstphaseofTuningabroadconsultationwasundertakenontheimportanceof‘generic competences’ at the first cycle level. This consultation involved employers,studentsandacademics,butnotfromwithinthenursingcommunity.Afourpointscale,with 4 being the most important, was used with respect to the importance of thecompetences. When this survey was undertaken with nurse educators, the mostdistinguishing,butnotsurprising,featurewasthemarkedfirstpreferenceforthecapacitytoapplyknowledgetopracticeasbeingthemostimportantcompetence.Theremainingcompetenceswereclusteredinsixgroupswithinterchangeablerankingwithinthegroup.The second group comprised ethical commitment and the skills of analysis, synthesis,problemsolvingandinterpersonalskills.Thethirdgrouppredominantlycomprisedskillsrelatingtothecapacitiestolearn,reflect,adaptandmakedecisionsinaninterdisciplinarycontext. The least important competencewas knowledge of a second language, whileskillsassociatedwithleadership,management,researchandenterprisewerefoundinthefifthandsixthgroups.Not-withstandingthesedifferences,thelowestscorerankingwas2.9(1-4)forthreecompetences,whiletherestwereover3,thatistosaythemajorityofthecompetenceswereratedasbeingatleast‘considerably’important.TheTuninggenericcompetencesweremodifiedinthelightoffeedbackandthesurveywas repeated in 2008, this time involving the nursing stakeholders. The nursingresponses once again demonstrated the importance of the generic competencesconcerningtheabilitytoapplytheorytopracticeandethicalcommitment.Withrespecttothesecondcycle,eachcompetencegainedinimportancefromthefirstcycle.In2004themostmarkeddifferenceswereinthefifthandsixthgroupings,namelyleadership,management,researchwheretheyhaveanincreasedimportanceatsecondcycle. Once again, these are not surprising findings and reflect the natural careerprogressionofaregisterednurse.

5.3 SubjectSpecificCompetences

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Aswereported in2008/2009, therewassignificantagreementconcerning thesubjectspecificcompetences.Countrydifferencesdidnotappearsignificant, tending toreflectcultural differences and the developmental stage of nursing within that country (forexampleknowledgeofasecondlanguageandtheorderingofresearchskills).Inrevisingthesecompetences,wehavetakenaccountoftheprevailingdemandsinsociety,needsoftheemploymentmarketandtheimpactofglobalisationandtechnologicaldevelopmentsinparticular.Thefollowingsubjectspecificcompetencesarethoseexpectedofthefirstcyclegraduatenurseatthepointofregistration.Thecompetencesarelistedunderthefivedimensionsof:1. Professionalvaluesandtheroleofthenurse2. Nursingpracticeandclinicaldecisionmaking3. Knowledgeandcognition4. Communicationandinterpersonalskills(includingtechnologyforcommunication)5. Leadership,managementandteamworking.Our revisions of the BN competences include the following modifications to reflectcontemporarypractiseandtheEUDirective(2015/55/EU)changes.

a) Additions:a) Demonstratestheabilitytorespondtocrisis/disastersinaprofessional

mannerb) Domain 1: Demonstrates the ability to practice in a manner which

demonstrates awareness and sensitivity towards different cultures,politicalandsocialrealities

c) Domain 2: Demonstrates the ability to recognise the impact of globalissuesonhealth,andhealthandsocialcaresystems

b) Amendments:a) Competence10:Needstorefertotheabilitytorecognisethespecific

needsassociatedwiththeconceptsandsituationsofchronicity,co-morbidityandsurvivorship.

b) Competence13and26:Needstorefertotheuseofmoderntechnologiesincommunicatingwith,andeducatingpatientsandrelatives.

c) Competence28:Needstorefertotheadaptability,flexibilityandcopingskillsrequiredforoptimalcaredeliveryindynamic/transienthealthcaresystems/contexts,andinsituationsofuncertainty.

d) Competence47:Needstorefertotheunderstandingoftheinfluenceandimpactofeconomicandfinancialelements,intheorganisationanddeliveryofcare

Thecompetenceswereeditedtostrengthenthestatementsandmakethemmoreexplicitandoutcomefocussed.Thefull2017listofrevisedsubjectspecificcompetencesislocatedinAppendix 1. The competenceswere thenmapped against the generic competences,whichdemonstratedoncemorethatthereisalignment.The revisedMasters level competences includemodifications to reflect contemporarypractise and the expansionof nurse specialists and advancednursepractitioners.Thepractice-based competences are themajor new addition. The full 2017 list of subjectspecificcompetencesislocatedinAppendix2

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5.4 Civic,socialandculturalengagementintegratedintothenursingdimensions.AsarticulatedintheAssessmentFramework,CALOHEEhasdevelopedaframeworkforCivic, social and cultural engagement. Within Nursing these elements have beenincorporatedaspartofthekeydimensionsoftheprofessionalcompetenceframework.Inthistablebelow,wedemonstratehowtheCivic,socialandculturalcompetencesarecrossreferencedexplicitlywithintheNursingCompetenceFramework.Domain

Societiesandcultures

Processesofinformationandcommunication

Processesofgovernanceanddecisionmaking

Ethics,norms,valuesandprofessionalstandards

Professionalvaluesandtheroleofthenurse

X X

Nursingpracticeandclinicaldecisionmaking

X X

Knowledgeandcognitivecompetencies

X X

Communicationandinterpersonalcompetencies

X X X

Leadership,managementandteamworking

X

The challenge now faced by SAG2 is to consider the extent to which these variouscompetences (generic, subject specific) can be measured so that appropriate andmeaningful assessment strategies can be designed aligned to the competences. It isacknowledgedthatProgrammeandteachingstrategieshaveaninfluenceonassessment.Weneedtodiscernwhatarethekeycompetencesthatprovidetheminimalacceptablestandard that shouldapply to anynurse irrespectiveof country. Similarly,weneed toidentifythetaskslinkedtothecompetenciesandtheirassociatedlearningoutcomes.Thismustbeundertakenwithrespecttoboththeoreticalandpracticebasedcompetences.ItisexpectedthattheclinicallearningexperienceforthegeneralnursecomplieswiththeAnnexoftheDirective.

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6. LeveldescriptorsforNursing1. Introduction

Section5hasoutlinedindetailthebackgroundanddevelopmentoftheleveldescriptorsfor nursing. Here we summarise the level descriptors in the context of our fivedimensionstodemonstratehowitisnecessarytoalignprofessionalnursingpracticewith academic levels; the achievement of professional competence (form novice toexpert); the acquisition of complex and complicated decision making skills; andtechnicalproceduralpractises.Conceptuallyanytypologywhichseparatesknowledgeartificallyfromskillsandwidercompetencescreatescanmispresenttheartistryandnuancesofprofessionalpractice.ThisisthelegacyofaCartesianapproachtoeducationand its analysis. Within a practice based discipline, the practise of ‘Holistic andindividualisedpersonalcentred’nursingcarerequirestheintegrationofallthedomainsofknowing,beinganddoingprofessionalpracticewhethertheiroriginsarefromthearts,sciencesorethicalpreceptsassociatedwithhumanpersons(seeGobbi,20056).

2. TheCALOHEEFrameworkofGeneralDescriptorsforNursing

Here we summarise the main features of the Professional Nursing DimensionsaccordingtotheEQFlevels.Thedimensionsincorporatetheseminalworksassociatedwith the forms of knowing in nursing, namely empirics, aesthetics, ethics, personalknowledge(Carper,19787)socio-politicalknowing(White,19958)andemancipatoryknowing (Chinn and Kramer, 20089). They also take account of the developmentalaspects of experiental learnng (Steinaker and Bell, 1979 10 ) and competencedevelopment(Benner,198411).

Table3CALOHEEFramework:Level6NURSINGwithregistration

Dimension Knowledge Skills WiderCompetencesResponsibilitiesandAutonomy)

1. Professionalvaluesandtheroleofthenurse

Theprofessional,moral,ethicaland/orlegalprinciples,dilemmasandissuesindaytodaypractice.

Theabilitytorespondappropriatelyandeffectivelytoprofessional,moral,ethicaland/orlegaldilemmasandissuesindaytodaypractice.

Withinthescopeofhis/herprofessionalpracticeandaccountability,theabilitytoadjusttheirroletorespondeffectivelytopopulation/patientneeds.Wherenecessaryandappropriatecanchallengecurrentsystemstomeetpopulation/patientneeds.

2. Nursingpracticeandclinicaldecisionmaking

Theprincples,concepts,practisesandproceduresthatunderpinthepracticeanddecisionmakingofdailynursingpractice.

Theabilitytomake,andenact,clinicaldecisionswithintheirScopeofPractice.TheabilitytofulfiltheScopeofPracticearticulatedatnationalandEuropeanlevel.Theablitytobeareflectivepractitioner.

Canreflectuponsocietalandpopulationhealthandsocialneeds,contributingasappropriatetopolicymaking.Familiarwithculturalcompetence.Hastechnicalskillsthatcanbeutilisedinthepublicspace.

6Gobbi, M. Nursing Practice as Bricoleur activity: a cocept explored. Nursing Inquiry, 12 (2) 117-125 7Carper, B. 1978. Fundamental Patterns of Knowing in Nursing. Advances in Nursing Science. 1 (1) 13-23 8White J. 1995. Patterns of Knowing: Review, critique, and update. Advances in Nursing Science. June. 17 (4) pp 73-86 9Chinn P.L. & Kramer M. 2008. Integrated Theory and Knowledge Development in Nursing, 7th edn. Mosby, St Louis, MI. 10Steinaker, N & Bell, R. 1979. The experiential taxonomy: A new approach to teaching and learning. Academic Press, London 11Benner, P. 1984. From novice to expert. Addison-Wesley, Menlo Park, California,

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3. Knowledgeandcognitivecompetences

Nursingtheories,knowledgeandconceptsofhealth,illhealth,wellbeing,Thehumanities,artsandsciencesnecessarytounderstandhumanbehaviour,bodyfunctioningandadaptiveresponsesindifferentculturesandcontexts.

Theabilitytoevaluateevidenceandapplythisevidencetoindividualclients,populationsandculturessoastodelivereffectivenursingcareinatimelymanner.

Awareoftheimpactofglobalisation,particualrlywithrespecttomigrationofstaffandpatientsandtheirhealthandwellbeing.Knowshowtocontributeinthepublic/civicspaceduringemergencyordisastersituations.

4. Communicationandinterpersonalcompetences

Theartandscienceofcommunicationinarangeofcircumstanceswithindividuals,groupsandpopulationsinadigitalage.

Communicatingeffectivelywithdiversepeoplesandabilitiesinarangeofsettingsusingappropriatemedia.

Cancommunicatewithlayandprofessionalgroupswithanappreciationof(P)politicalcontexts.

5. Leadershipandteamworking

Fromtheperspectiveofanewregistrant.Theoriesandmodelsofleadership,followership,managementandteamswithinhealthandsocialcarecontexts.

Abletoleadandworkcollaborativelyinclinical/healthcareteams.Abletosupervisecolleaguesandjuniorstaff.

Abilitytoworkinterculturallyandinterprofessionallywithbothlayandprofessionalgroups.

Table4CALOHEEFramework:Level7NURSING

Dimension Knowledge Skills WiderCompetences(ResponsibilitiesandAutonomy)

1. Professionalvaluesandtheroleofthenurse

Withinaglobalcontext,canidentifyfuturetrendsandchallengeswithrespecttotheprofessional,moral,ethicaland/orlegalprinciples,dilemmasandissuesindaytodaypracticewithinaglobalcontext

Exhibitsautonomyandleadershipinthemanagementandsupervisionofcontemporarychallengesinnursingandhealthcarepractice.WorksattheboundariesoftheScopeofPracticewhichmaybeextendedtoimprovenursingcarepractises.

Criticallycontributestothepublichealthandcivicagendathroughanawarenessofglobal,nationalandlocaltrends.

2. Nursingpracticeandclinicaldecisionmaking

Fromasystemsandleadershipperspective,appraisestheprinciples,concepts,practisesandproceduresthatunderpinthepracticeanddecisionmakingofnursingpractice.

Criticallyappliesbestavailableevidencetoeachdecisionandnursingaction.Promotesclientwell-beinginallsituations.Canself-evaluate.

Canapplyarangeofnursingskillsanddecisionmakingtechniqueswithinciviclife.

3. Knowledgeandcognitivecompetences

Specialistknowledgeofthenursingtheories,knowledgeandconceptsofhealth,illhealth,wellbeing,thehumanities,artsandsciencesnecessarytounderstandhumanbehaviour,bodyfunctioningandadaptiveresponsesindifferentculturesandcontexts.

Criticallyanalysesandsynthesisesbestavailableevidencetoalldivisions.Canuseinvestigativetoolstoevaluatepractise.Caninitiatenewpractisestomeetclientneeds.

Promotesandcontributesevidencebasedguidelines,policiesandknowledgeinthecivicsphere.

4. Communicationandinterpersonalcompetences

Fromasystemsandleadershipperspective,andinthecontextofspecialistareasofpractice:Theartandscienceofcommunicationinarangeofchallengingcircumstanceswithindividuals,groupsandpopulationsinadigitalage.

Exhibitstheablitytoprevent,resolveandmanageconflicts.Handlesdifficultconversationswithinaninterprofessionalenvironment(advocacy,whistleblowing,safeguarding).Effectivelyusesarangeofcommunicationskills.

Usesarangeofcommunicationtechnologiesandstrategiesintheirpersonal,public/civicandprofessionallife.Skilledinreflectivepractice.

5. Leadershipandteamworking

Fromasystemsandleadershipperspective,andinthecontextofspecialistareasofpractice:Theoriesandmodelsofleadershiop,followership,managementandteamswithinhealthandsocialcarecontexts

Leadsuniandinterdisciplinaryteamsincomplicatedandunpredictablesituations.Initiatesandinnovatesqualityimprovementprogrammes.Rolemodelsexpertiseandcoaches/teachesothers.Effectivelyusesresources.

Comprehendsissuesassociatedwithleadership,managementandteamworkingwithincivicorganisations.Playsakeyroleinepidemics,disasteroremergencysituations.

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8. Learning,TeachingandAssessment8.1 Pedagogy

The SAG1 group demonstrated the range and diversity of pedagogies used in nurseeducationandarticulatedtheirrelationshiptotheacademic level,degreeofautonomyandscopeofpracticeoftheindividualnursesituatedwithintheircontextofcare.SAG2’ssurveysimilarlyreflectedthisdiversitywithanincreaseintheuseofstudentfocussedpedagogueslikepeerreview,‘flippedclassroom’,blendedlearning,roleplay/simulation.With the advent of Smart technologies andmore accessiblemobile internet facilities,nurseeducationnowincorporatesgaming,andothertechnologiesforlearning.

Thenotionofdifferentiationiscrucialtonursingtoenabledevelopment,progressionandachievementofsafe,intelligentpracticeintheworldofpatientsandtheirfamilies/lovedones.Manytypologiesoflearningdonotaccordvaluetotheroleofapprenticeship,craftknowledgeandskillacquisitionthatareoftenfundamentaltolearninginaperson-basedpractice.ThroughouranalysisofnursinginvariousEuropeancountries,thereisaplacefor a variety of learning and teaching models in nurse education, these are used indifferentproportionsaccordingtotheresourcesavailableandthedevelopmentalstageof the learner. Traditional models still have an important place in teaching/learningnursingfornovices,orattheearlystageofamorecomplexcompetenceacquisition.Thesemethodsarerelevanttothedevelopmentofsafepractice,forexamplelearningmovingandhandlingofpatientsandtheabilitytocarryoutproceduressafely.Whatisnowknownas‘Craftknowledge’isoftenpassedonfrompersontoperson,anditisappropriatetodoso in workplaces where role modelling and coaching develop practices ahead of theevidencebase.Thisappliestobothnovicesandexperts.

Whenhumanandmaterialresourcesbecomeavailable,innovativeteachingandlearningstrategies are increasingly utilised. This includes the use of reflective and criticalapproachestolearningtogetherwiththeuseofinformaticsthatsupportwebbasedandworkplacelearning.Practicalskillsareoftendevelopedthroughobservationofpractice,demonstrations, simulations, role play and exposure and engagement in clinicalexperiences. However, many countries reported the challenges encountered duringclinicalplacementswithstudentsupervisionandthequalityofpatientcare.Therealityis that when they become available, resources are allocated to support learners inpractice, topreparestudents forpractice throughclinicallybasedwards, clinical skillslaboratoriesandincreasinglyusesimulationsorvirtualpractice.WeagreewiththeSAG1group and their collaborating stakeholders who considered it unsatisfactory, andpotentiallyhazardoustopatients,whenstudentnursesareinadequatelysupportedintheclinical learning environment. Students require support from suitably qualifiedregisterednurseswhohavebeenspeciallypreparedtohelpstudentslearnandachievetheirpracticalandprofessionalcompetences in theworkplace.Employerand financialcommitmentisessentialtoenabletheregisterednursestoattendcontinuingeducationso they can be equipped to teach, supervise and assess students in practice. Ideally,studentsshouldbesupplementarytotheworkplaceandthereforefacilitatedtoobservecare; practice under supervision, receive feedback on their performance and havesufficientlearningopportunitiestodevelopthenecessarycompetences.Studentsshouldhave experience that reflects the challenging needs of increasingly diverse health andsocialcaresettings.

Thewaythatcurriculaaredevelopedisnotonlycultural,butinnursingalsoreflectsthestage of development of nursing within that country and where it is situated andcontrolled. In some countries curricula are legislated, inothers learningoutcomesarenationallydefinedandinothers,norequirementsbeyondconformitytotheEUDirectiveare set.Curriculumexpression reflects also the curriculumdesign, resourcesavailable

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and teacher/student capabilities. Assessment strategies in nursing at first cycle withregistrationneedtoaddressboththeoreticalandpracticalbasedlearningasidentifiedinthe subject specific competences in the original Tuning project. The thesis or specialprojectrequiredinthefirstcycleassessesgenericcompetencies.Diversestrategiesareusedtoreflecttheassessmentofknowledge,skills,attributesandprofessionalvalues.AvarietyofassessmentstrategiesshouldbeutilisedtoreflectthediversityofteachingandlearningapproachesusedacrosstheEUcountries.Intheinterestsofpublicsafety,eachprogrammewillidentifycorecomponentsthatmustbe‘passed’inordertoachievethenecessarylicence/registrationtopractice.Table5Anexampleoflearning,teachingandassessingstrategiestoachieveanursingcompetencerelevanttothesubjectarea

Competencetobeachievedattheendofthecourse.Whatdoesthiscompetencemeanforstudents?

Potentiallearningoutcomes(LO)foundinunits/modulesduringthecoursetoachievethecompetence.Placedinorderofincreasingcomplexity.(Abilityto...)

Possiblelearningandteachingstrategies/methods/pedagogies.Howarestudentshelpedtoacquirethiscompetence?

Howdoyouassesswhether,ortowhatdegreetheyhaveachievedthiscompetence(progression)?Howdostudentsknowwhether,ortowhatdegreetheyhaveachievedthiscompetenceandifnotwhytheyhavenotachievedit?

Canpracticewithinthecontextofprofessional,ethical,regulatoryandlegalcodes,recognisingandrespondingtomoral/ethicaldilemmasandissuesindaytodaypractice.Isawareofthedifferentroles,responsibilitiesandfunctionsofanurse.Thestudentcanfullyrealisewhatitmeanstobearegisterednurse,andtocarryouttheduties,responsibilitiesandpracticesthatareassociatedwiththisrolewithinthehealthcareteamandsociety.

Demonstrateanunderstandingofnursingasasubject/scienceandasaprofession.Explainanddemonstratethelegalandethicalresponsibilitiesofaregisterednurseandotherhealthcareworkers.ApplyknowledgeoftherelevantActstothepatients’legalrights.ApplyknowledgeoftherelevantActsandpoliciestothepatientasacitizenandtheirrightsanddutiesinfinancialandsocialmatters.Explainandpracticeaccordingtothelegalandethicalcodexfornurses.Updatesknowledgeinthisfield.

Lecturesore-learningpackagestointroducethetopic.Guidedreadingofethicalconceptsandapplication,codesofpractice.Videosandanalysisofcriticalincidents.Discussionsanddebatesfocusedinpracticeexamples:professional/ethicaldilemmasinpractice.Roleplayandsimulationexercises.Groupwork.Presentinginplenarysessions.Supervisedclinicalpracticalexperienceindifferenthealthandsocialcaresettings.

Thiscompetencewouldbeassessedthroughoutthecourseboththeoreticallyandpractically.Itiscommontohavespecificassessmentcriteriarelatedtothiscompetence.Persistentfailuretoachievethiscompetenceisusuallyveryserious.Thiscompetencewouldbeassesseddirectlyandalsoindirectlythroughinferencesmadeinothers.Itcoversseveralgenericcompetencesforexampleethicalcommitment.Feedbackfromacademicassessmentswouldguidethestudenttowardstheirtheoreticalunderstandingandapplicationtopractice.Thestyleoftheoreticalassessmentswouldbescrutinisedforevidenceofunderstandingandapplyingthese.Feedbackfromclinicalpracticalassessmentswouldindicatelevelofachievement(oftenthroughportfolios,structuredassessmentsandclinicalreportsfrompractisingnurses).

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Awarenessoftheintentionsingenerallegislationasitappliestothenursingcontext.

Increasingresponsibilityinpractice.

8.2 QualityEnhancement

Quality enhancement in nursing addresses theoretical and clinical, practical or work-basedlearning,toenablethestudenttomeettheaimsandoutcomesofthecurriculum.Thecurrentsituationrelatingtotherolesandrespectiveaccountabilityforthequalityoftheclinicallearningenvironmentareoutlinedonthewebsitewhereatabledemonstratesthe complex stakeholder involvements in student learning in practice and the role ofcompetent authorities. In some countries, there are nowmandatory requirements forlearning and development after registration: these are often associated withrevalidationrequirementsforthelicencerenewal.Therearealsocountrieswithspecifiedcompetencesorexpectationsassociatedwithadvancedorspecialistnursepractitionerroles.

Thereissignificantevidencetoconfirmthatqualityintheclinicallearningenvironmentis related tohowstudentsare treated (humanisticornot), teamspirit, leadershipandmanagementstyleoftheseniorclinicianandavailablesupportforteachingandlearning.Auditsofclinicallearningenvironmentsmaybeundertakenbytheeducationalprovider,regulatorybodiesorqualityassuranceagencies. In thesesituations it is typical for thefollowingitemstobeconsidered:

• Number,experience,qualificationsandmixofclinicalstaff• Motivationofstaff• Researchorevidencebaseofclinicalpractice• Patient/staffratios• Relationshipbetweeneducationalistsandclinicians• Philosophyofnursingcare• Learningopportunitiesandsupervision• Developmentofstaff• Qualityofpatientcare

These elements augment those previously identified issues within the TUNINGmethodology forqualityenhancementandcanbeapplied toothersimilarworkbasedlearning programmes. They also indicate the dilemma faced by Higher EducationInstitutions whomay have limited control over the clinical environment where theirstudentsareplaced.Theinvolvementofstakeholdersinqualityenhancementisthereforecrucial. This is achieved through partnership and finance arrangements, staffdevelopment, audit, action plans, and feedback from students, external agencies andacademicstaff.

In the overview to this brochure, itwas acknowledged that countries are at differentstagesofdevelopmentwith respect to thenursingprofessionand the educationof itsmembers.Similarly,resourceallocationisvariable.Inthetransitionfromcontentbased,inputledcurriculatocompetencebased,ECTSandQualificationsFrameworkcompatiblecurricula, staff andstudents continue toneeddevelopment. Sucha transitionwill alsoaffectnonnursingpersonnelinHigherEducationandHealthCaresettings(forexampleacademicregistrars,medicalstaff,administrationsystems).Therewillbeanassociatedadditional workload to achieve a quality based and rigorous ‘new model’ of nurseeducation.Insomecountriesthiswillstretchalreadyoverworkedfacilities.Wesupporttheviewofourstakeholdersthatthedevelopmentoftoolstoenablecountriestomake

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impactassessmentswouldbeahelpfulwayforward.Thisimpactassessmentshouldtakeintoaccount the impactuponuniversity andnon-university sectors, theavailabilityofacademicandpracticestafftosupportlearnersandthecapacity(intermsofresources)totransfersignificantnumbersofstudentstodegreeprogrammesandtoprovidepostregistrationopportunitieswithrecognizablequalifications.

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9. SomeReflectionsonthePostGraduateCycles

Beforediscussingthedoctoralcontext,itisimportanttoconsiderthecurrentsecondcyclesituation(masters’level)innursingandnursingscienceinEurope.Withtheexpansionofgraduatestatusinmanycountries,secondcycleeducationiswitnessingrapidexpansionwithin the economic constraints of the countries concerned and the availability ofacademicandclinicallecturers/supervisorsinnursing.Thecurrentsituationinsecondcycle programmes atUniversities in theTuning countries can be grouped in to types,whichare(1)atheoreticaltype(e.g.nursingscience)and(2)aclinicaltype(e.g.AdvancedNursePractitioner,NurseSpecialist).Thedevelopmentofthesecondcycleprogrammesisanessentialplatformfortheachievementofavalidandsufficientresearchcapacityatdoctoralandpost-doctorallevel.

The student is usually supported through supervision (academic and/or clinical)particularlyifthereisaspecialprojectordissertationorrequiredclinicalexperience.Theassessmentstrategyuniformlycomprisedamixtureofdifferentmethods,e.g.asVIVA,thesis,examination,projectsorbycreditsinamodularsystem.Athesisiscompulsoryforallcountries.Afterpassingtheassessmentsandgainingthequalification,graduatesworkas a lecturer, teacher in practice and/or theory, clinical specialist/advanced nursepractitioner,aresearcherorhaveafunctioninthemanagementorpolicyarea.

9.1 ThirdCycleEducation

Whileas,Meleispointedoutoveradecadeago,doctoraleducation innursing is fairlyrecent when compared with other traditional disciplines (Meleis in Ketefian andMcKenna,2005),doctoraleducationinnursingisnowprevalentinmorecountriesthan2008/9.

ThecurrentsituationinthirdcycleprogrammesatUniversitiesintheTuningcountriescanbegroupedinthreecategories,namely(1)CountrieswithPhDinnursingornursingscience;(2)countrieswithaclinicalorataughtdoctorateinnursing;and.(3)countrieswith no third cycle education in nursing in their own country. In the latter situationdoctoralstudentshavetocontinuetheireducationincountrieswithaPhDinnursingor–asitwasthecaseinthebeginningofnursingscienceinallcountries–continuetheirstudies in their own country in related disciplines i.e. social science, public health,anthropology,education,philosophyetc.Theabilitytosupervisenursingasadisciplineinitsownrightcanthusbeenrichedorhinderedbytheexpertiseandexperienceofthesupervisor with respect to nursing practice and theory. The dominance of ‘out ofdiscipline’influencesuponthestudyofnursingtheoryandpracticeiswelldocumented.There is also a variation in the countries with a third cycle nursing/nursing scienceprogramme.Insomecountriesthemainsubjectcanbenursingsciencewheninothersit(is) could be nurse education, epidemiology or public health. This echoes earliercommentswherenursesmayormaynotbesupervisedbyacademicswhoarethemselvesnurses,oracademicallyqualifiedinthetheoryorpracticeofnursing.

Admissioncriteriaforthe3rdcyclestudiesinnursing/nursingscienceismainlythroughthesuccessful completionofa2nd cycledegree,with theexceptionofGermany,wherestudents currently have to complete four years of study after their academic diplomaRN.IntheUKagoodfirstcycledegreemaygivedirectaccesstodoctoralstudies,althoughmasters level achievement is preferred. The current situation can be defined as atransitional period, meaning that clinical work experience and studies are differentlyvalued in the participating countries, also reflecting the role and scope of practice ofnurses. Where this transition period is being supported by the recognition of priorlearning, sometimes exemptions are given on the basis ofcompetences/learningdemonstratedfromworkexperienceandstudies.Theremaybeadditionalrequirements,

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especially for the professional/clinical doctorates where specified academic/clinicalcompetencesmaybenecessary.

Thenormallengthofthethirdcycleeducationisspecifiedinsomecountries(e.g.threeyears) while in others, like Finland it is completed with 60 ECTS credits (worth) ofadvancedstudiesordoctoralcoursesinadditiontothethesis.ThemorerecentClinicalorProfessional doctorate programmes usually have credit allocations that reflect threeyearsfulltimestudyaccordingtotherespectiveNationalQualificationFramework(e.g.UK). They can also include credit for the achievement of clinically or work relatedcompetencesatthislevel.TheTuningmembersconsideredthattherewasmerittotheresearchtrainingprogrammehavingaspecificcreditallocationfordemonstrationofthegenericresearchskillstrainingcompetences.Itwaslessclearhowtoallocatecreditfortheresearchoutputorpracticecompetences.

Assessment

Avarietyofassessmentstrategiesisusedfortheempiricaltraditional3rdcyclePhD.Theseinclude,thesis,publication(whichmightbepartofthethesis),athesisdefenceorviva,examinations, and/or a project (fromproposal development todefence), anddoctoralcourses.Withintheprofessionaldoctorate,theremaybeprojectwork,assignmentsandthe development of a portfolio of competence in the work related activities. Peerassessment, presentations at international conferences or poster work may beexpectationsofthedoctoralstudent/candidateduringthecourseoftheirstudies.

Research,LearningandSupervisionenvironment.

Currently, the majority of the countries in SAG2 now offer third cycle education innursing/nursing science, whereas in 2008 only eight out of fourteen countries hadnursingstudiesatdoctorallevel.Insomecountries,onlyoneortwouniversitiesoffertheprogramme,whileinothers,allorseveralresearchactiveuniversitieshaveestablishednursing departments or units. There is no doubt that a good supervisory relationshipsituatedinaresearchactiveenvironmentiscrucialtothesupportandachievementofthedoctoralstudents.With theprofessional/clinicaldoctoratestudents, it isessential thatthisisalsocomplementedbyasupportiveworkingenvironmenttoenablethestudenttohaveaccesstothelearningopportunitiesthatwillenablethemtoachievethenecessarywork/clinicallybasedoutcomes.

9.2. TrendsandConcerns

IthasbeenpreviouslynotedthatNursingisanemergingacademicdiscipline,particularlyvulnerabletosocioeconomicconstraintsduetoitspersonnelcostsandrelationshipswiththeHealthSectorandmedicine.Inordertoexpandpostgraduateeducationandresearchoutputs in nursing, a greater research capacity is required which itself is reliant onsufficientpost-doctoralscholars.Thechallengeremainstoprovidesufficientandrobustsecondandthirdcycleprogrammes,researchactiveenvironmentsandsufficientqualitysupervisors who are themselves research active. A major concern is the paucity offunding, whether at national or international level, to support doctoral education fornursesinnursingandmorecrucially,todevelopsufficientresearchcapacityinthefieldofnursing.This is indirectcontrast tonurseresearchersandacademicsbeingviewedas‘researchassistantsoradjuncts’tomedicineorbioscience.Anotherconcernisthelackofresearch funding assigned to nursing research or nursing related issues that are ofpractical relevance to patients, clients and their families. For example, current andpredicted epidemiological demands associated with longevity suggest the need forresearch into challenging and enduring care issues like dementia, rehabilitation,continence, immobility and the best utilisation of the nursing workforce for optimalpublichealthandqualityoflife.Thecontributionofnursestothesocial,educationalandeconomic development of Europe cannot be underestimated given the well-known

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demographic andmigrationpatterns inEurope, and the role ofwomenwho form thelargest proportion of the nursing workforce. Fortunately, the recent 7th and 8thFramework Research Programmes have supported significant nursing researchprogrammes.

Developingrobustthirdcycleandresearchprogrammesinnursingiscrucial. Ifnursesare tobesignificant internationalresearchcollaboratorsandpoliticallyrepresentedatleadershipandpolicymakinglevelsinthefieldsofhealthandsocialcare.Post-doctoralresearch fellowships, specialist training and ‘emerging researcher’ funding streamsspecifically designated or ‘ring fenced’ for the discipline are also necessary. They arenoticeably absent in most countries. When there is an absent experiencedacademic/researcher nursing ‘voice’ in multidisciplinary research, public health andpolicymaking,thedevelopmentofnational/Europeanpolicyandthebestuseofpublicmoniesisimpoverished.

Thirdcycleeducation,whetherfundedbytheindividualorsponsoredfullyorpartiallybyemployers/governmentagenciesisexpensive,particularlyifseniorpractitionersoreducatorsrequiresalaryprotectionduringtheirstudyperiod.Itisthereforeimportantthatcareeropportunitiesandstructuresenablethebestutilisationofgraduateachievementsandenablefurtherdevelopmentoftheprofessioninascientific,robustandevidencebasedpracticemanner.Internationalco-operation,exchangevisitsandmultilevelinstitutionalandresearchcollaborationswouldenablehighereducationinstitutionstosharetheirexpertiseandbuildtheresearchcapacityinnursingpracticeandtheory.

There are growing international networks of nurse researchers and associationsconcernedwithdoctoraleducationandresearch.Forexample:theInternationalNetworkfor Doctoral Education in Nursing- http://www.umich.edu/~inden/ providesinformation on quality standards for doctoral education and ways of collaboratinginternationally.Koff(2016)providesausefuloverviewofNursingintheEuropeanUnion,building on the earlierwork of Ketefian andMcKenna (2005)who provided an earlycomprehensiveglobaloverviewofdoctoraleducationinnursingthatofferssubstantivedatainthisarea.

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10. OtherUsefulLinksandInformationaboutourKeyStakeholders

TheSAG1andSAG2membersreceivedsignificantsupportandencouragementfromtheEuropeanstakeholdersandoffertheirsincerethanksfortheircontributiontothecurrentandfutureTuningoutcomes.

EFNTheEuropeanFederationofNursesAssociations(EFN),formerStandingCommitteeofNursesoftheEU(PCN),wasestablishedin1971,torepresentthenursingprofessionandits intereststotheEuropeanInstitutions,basedonthenursingeducationandfreemovement Directives being drafted by the European Commission then, and is theindependentvoiceofthenursingprofession,representingmorethanonemillionnursesatEuropeanLevel.EFNmembersaredrawnfromtheNationalNursesAssociationsfromthetwenty-sevenEUMemberStates(+Croatia,Norway,IcelandandSwitzerland),whichare inmembershipwith the International Council of Nurses (ICN) and the Council ofEurope,anditsAssociatedmembersarethreemandatedrepresentativesoftheEuropeanNursingSpecialistandGenericOrganisations.TheInternationalCouncilofNurses(ICN),theWorldHealthOrganisation(WHO)andtheEuropeanNursingStudentsAssociation(ENSA)areholdingobserverstatuswithinEFNGeneralAssembly.www.efnweb.orgThemissionofEFNistosafeguardthestatusandpracticeoftheprofessionofnursingandtheinterestsofnursesintheEUandEurope.ClosduParnasse,11A-B-1050Brussels–Belgium

FEPI EuropeanCouncilofNursingRegulators(FEPI-FederazioneEuropeaProfessioniInfermieristiche).FEPIisanewEuropeannetworkofnursingregulatorswhichisworkingtogethertoinfluenceEUpolicydevelopmentandprovideadvocacyfornursingregulation.Italsoprovidesaplatformfortheexchangeofinformationamongregulatorybodiesandcompetentauthoritiesfornursing.FEPI'smissionispatientsafetyandpublicprotectionthroughhighnursingstandardsforeducationandpracticeandthustheprotectionoftheEuropeancitizens.www.fepi.orgFEPIc/oIPASVI,Coudenberg70,Brussels1000,Belgium

FINEEuropeanFederationofNurseEducators-wasestablishedin1995anditsobjectiveistopromotethecontinuingdevelopmentofexcellenceinnursingeducationinEurope.C/oCEFIEC-6,rueJeanJaures-94190VilleneuveStGeorges–Francehttp://www.fine-europe.eu

IDEN the International Network for Doctoral Education in Nursing-http://www.umich.edu/~inden/

ENDA TheEuropeanNurseDirectorsAssociationwas established in1995 in order tosupport nursing leadership. The key aims for the Association are to strengthen thenursingcontributiontopolicymakinginthecontextofhealthcaremanagementinEurope,tofurtherthedevelopmentoftheartandscienceofnursingleadershipandmanagementinEuropeandtoestablishformallinksbetweenNurseDirectorsacrossEuropetosupporta communication network of experts. www.eu-nurse-leaders.org Prof. J Wilkins. HonPresident. Woodside Mill, West Woodside, Wigton. CA7 OLW UK. Emailjacquifilkins@hotmail.com

ICN The International Council of Nurses is a federation of 129 national nursesassociationsrepresentingthemillionsofnursesworldwide.ICNistheinternationalvoiceofnursingandworkstoensurequality forallandsoundhealthpoliciesglobally.Web:www.icn.ch3,PlaceJeanMarteau-1201-Geneva–Switzerland.

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ReferencesAiken,L.H.,Sloane,D.M.,Bruyneel,L.,VandenHeede,K.,Griffiths,P.,Busse,R.,Sermeus,W.(2014).NursestaffingandeducationandhospitalmortalityinnineEuropeancountries:aretrospectiveobservationalstudy.Lancet,1-7.DOI:10.1016/S0140-6736(13)62631-8

Ball,J.,Griffiths,P.,Rafferty,A.,Lindqvist,R.,Murrells,T.,&Tishelman,C.(2016).Acrosssectionalstudyof‘careleftundone’onnursingshiftsinhospitals.JournalofAdvancedNursing,1-17.DOI:10.1111/jan.12976

BarrH(1998)Competenttocollaborate:Towardsacompetency-basedmodelforinterprofessionaleducation,JournalofInterprofessionalCare,12:2,181-187,DOI:10.3109/13561829809014104

Dall'ora,C.,Griffiths,P.,Ball,J.,&RecioSaucedo,A.(2016).Characteristicsofshiftworkandtheirimpactonemployeeperformanceandwellbeing:aliteraturereview.InternationalJournalofNursingStudies,58,12-27.DOI:10.1016/j.ijnurstu.2016.01.007

Gobbi,M.(2014).NursingLeadershipintheEuropeanlandscape:influence,realityandpolitics.JournalofResearchinNursing.19:636-646.doi:10.1177/1744987114557109.

Gobbi,M.(2016).Chapter6:Globalissuesfornursingleadership.InR.Taylor,&W-H.Brian(Eds.),TheEssentialsofNursingLeadership.London,GB:SAGE.

Griffiths,P.,Dall'Ora,C.,&Ball,J.(2017).Nursestaffinglevels,qualityandoutcomesofcareinNHShospitalwards:whatdoestheevidencesay?HealthWork:EvidenceBriefs,1(1).

InternationalCouncilofNurses(ICN)2003ICNFrameworkofCompetencesfortheGeneralistNurse.ICN,Geneva.

ICN2004ScopeofNursingPractice.ICNGeneva.Revisionof1998version.

InternationalLabourConference(63rd:1977:Geneva).Employmentandconditionsofworkandlifeofnursingpersonnel/sixthitemontheagenda[ofthe]InternationalLabourConference,63rdsession,1977.Geneva:ILO,1976

Ketefian,SandMcKennaH.2005.DoctoralEducationinNursing:InternationalPerspectives.Routledge,London.

Koff,S,(2016).NursingintheEuropeanUnion:AnatomyofaProfession.Volume1.TransactionPublishers,NewBrunswick

OfficialJournaloftheEuropeanCommunities.Legislation.Vol.20.No.176.15thJuly1977.

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WorldHealthOrganization&SigmaThetaTauInternational.2007.GlobalStandardsforInitialNursingandMidwiferyEducation.

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Appendixes

Appendix1A2017Subjectspecificcompetences-BachelorslevelwithregistrationPleasenotetheuseoftheterm‘patient’astheinclusiveterm.

Competences2017Dimension1:Theprofessionalvaluesandtheroleofthenurseassociated

competences1) Practiceswithinthecontextofprofessional,ethical,regulatoryandlegalcodes,

recognisingandrespondingtomoral/ethicaldilemmasandissuesindaytodaypractice.

2) Practicesinaholistic,tolerant,non-judgmental,caringandsensitivemanner,ensuringthattherights,beliefsandwishesofdifferentindividualsandgroupsarenotcompromised.

3) Educates,facilitates,supports,promotesandencouragesthehealth,well-beingandcomfortofpopulations,communities,groups,familiesandindividualswhoselivesareaffectedbyillhealth,distress,disease,disabilityordeath.

4) Withinthescopeofhis/herprofessionalpracticeandaccountability,isawareofthedifferentroles,responsibilitiesandfunctionsofanurse,andisabletoadjusttheirroletorespondeffectivelytopopulation/patientneeds.Wherenecessaryandappropriateisabletochallengecurrentsystemstomeetpopulation/patientneeds.

5) Acceptsresponsibilityforhis/herownprofessionaldevelopmentandlearning,usingevaluationasawaytoreflectandimproveupononhis/herperformanceandtoenhancethequalityofservicedelivery.

6) IsabletojustifyandarticulatetherelevanttheoreticalandresearchunderpinningstotheirprofessionalpracticeDimension2:Nursingpracticeandclinicaldecisionmakingcompetences.

7) Undertakescomprehensiveandsystematicassessmentsusingthetools/frameworks

appropriatetothepatienttakingintoaccountrelevantphysical,social,cultural,psychological,spiritualandenvironmentfactors.

8) Abletoundertakeaneffectiveriskassessmentandtakeappropriateactions9) Abletorecogniseandinterpretsignsofnormalandchanginghealth/illhealth,distress,

ordisabilityintheperson(assessment/diagnosis).10) Respondstopatientneedsbyplanning,deliveringandevaluatingappropriateand

individualisedprogrammesofcareworkinginpartnershipwiththepatient,theircarers,familiesandotherhealth/socialworkers.

11) Abletocriticallyquestion,evaluate,interpretandsynthesisarangeofinformationanddatasourcestofacilitatepatientchoice,andtomakesoundclinicaljudgmentstoensurequalitystandardsaremetandpracticeisevidencebased.

12) Abletousemoderntechnologiestoassessandrespondappropriatelytoclientneed(forexamplethroughtelenursing,multimediaandwebbasedresources)

13) Abletoappropriatelyusearangeofnursingskills,medicaldevices,interventions/activitiestoprovideoptimumcare.Forexample:a) maintainspatientdignity,privacyandconfidentiality;b) practiseprinciplesofhealthandsafety,includingmovingandhandling,infection

control;essentialfirstaidandemergencyprocedures;c) safelyadministersmedicinesandothertherapies;d) considersemotional,physicalandpersonalcare,includingmeetingtheneedfor

comfort,nutrition,personalhygieneandenablingthepersontomaintaintheactivitiesnecessaryfordailylife;

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e) respondstoindividualsneedsthroughthelifespanandhealth/illnessexperiencee.g.pain,lifechoices,revalidation,invalidityorwhendying;

f) informs,educatesandsupervisepatient/carersandtheirfamilies.

Dimension3:Knowledgeandcognitivecompetences14) Hascurrentandrelevantknowledgeofthefollowingandcanappropriatelyapplythis

knowledgetonursingpractice,patientcareandsituationsofuncertainty:a) Theoriesofnursingandnursingpracticeb) TheoriesandviewsconcerningthenatureandchallengesofProfessionalpracticec) Naturalandlifesciencesd) Social,healthandbehaviouralsciencese) Ethics,lawandhumanitiesf) Technologyandhealthcareinformaticsg) Internationalandnationalpoliciesh) Problemsolving,decisionmakingandmanagingtensionorconflicti) Theoriesofpersonalandprofessionaldevelopment

15) TohavesufficientknowledgeoftheResearchProcessandcurrentnursingresearch,so

astobeabletoapplythisknowledgetoclinicalpracticeandothernursingactivitiesandthereforeprovidenursingcarewhichisrigorousandevidencebased.

Dimension4:Communicationandinterpersonalcompetences(includingtechnologyforcommunication)

16) Abletocommunicateeffectively(includingtheuseofnewtechnologies):withpatients,familiesandsocialgroups,includingthosewithcommunicationdifficulties.

17) Enablespatientsandtheircarerstoexpresstheirconcernsandworriesandcanrespondappropriatelye.g.emotional,social,psychological,spiritualorphysical.

18) Abletoappropriatelyrepresentthepatient’sperspectiveandacttopreventabuse.19) Can use a range of communication techniques to promote patient well-being. For

exampletheabilitytoappropriately:a) usecounsellingskills;b) identifyandmanagechallengingbehaviour;c) recogniseandmanageanxiety,stressanddepression;d) give emotional support and identify when specialist counselling or other

interventionsareneedede) identifyopportunitiesforhealthpromotionandhealtheducationactivities

20) Able to accurately report, record, document and refer care using appropriatetechnologies.

Dimension5:Leadership,managementandteamcompetences21) Realisesthatpatientwell-beingisachievedthroughthecombinedresourcesand

collaborativeactionsofallmembersofthehealth/socialcareteam,andisabletoleadandco-ordinateateam,delegatingcareappropriatelyandmeaningfully.

22) Abletoworkandcommunicatecollaborativelyandeffectivelywithothernursesinthebestinterestsofthepatient

23) Abletoworkandcommunicatecollaborativelyandeffectivelywithothermembersoftheinterprofessionalteaminthebestinterestsofthepatient.

24) Abletoworkandcommunicatecollaborativelyandeffectivelywithallsupportstafftoprioritiseandmanagetimeeffectivelywhilequalitystandardsaremet.

25) Abletoassessriskandactivelypromotethewell-being,securityandsafetyofallpeopleintheworkingenvironment(includingthemselves).

26) Criticallyusestoolstoevaluateandauditcareaccordingtorelevantqualitystandards.27) Withintheclinicalcontext,demonstratestheabilitytoeducate,facilitate,superviseand

supportnursingstudentsandotherhealth/socialcarestudents/workers.28) Isawareoftheprinciplesofhealth/socialcarefundingandusesresourceseffectively

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Appendix1B–2018Subjectspecificcompetences:MastersLevelincludingpracticebasedcompetencesPleasenotetheuseoftheterm‘patient’asaninclusiveterm.

2018CompetencesDimension1:Theprofessionalvaluesandtheroleofthenurseassociatedcompetences1.Demonstratestheabilitytopractisewithinthecontextofprofessional,ethical,regulatoryandlegalcodes,recognisingandrespondingtomoral/ethicaldilemmasandissuesindailypracticeandthepublicspace.2.Demonstratestheabilitytopractiseinaholistic,tolerant,non-judgmental,caringandsensitivemanner,ensuringthattherights,beliefsandwishesofdifferentindividualsandgroupsarenotcompromised.3.Demonstratestheabilitytoeducate,facilitate,promote,supportandencouragethehealth,wellbeingandcomfortofpopulations,communities,groupsandindividualswhoselivesareaffectedby,illdeath,distress,disease,disabilityordeath.4.Demonstratesadvancedunderstandingofthedifferentroles,responsibilitiesandfunctionsofanurse,andisabletoevaluateand,ifappropriate,adjusttheirroletorespondeffectivelytopopulation/patientneedswithinthescopeofhis/herprofessionalpracticeandaccountability.5.Demonstratestheabilitytoacceptresponsibilityforhis/herownprofessionaldevelopmentandlearning,usingevaluationasawaytoreflectandimproveuponhis/herperformancetoenhancethequalityofservicedeliveryandpatientoutcomes.6.Demonstratestheabilitytocriticallyevaluatetheappropriatenessofvariousmethodsofanalysisandcomplexissuesinnursingandnursingsciencefromanacademicandadvancedprofessionalnursingperspective7.DemonstratesspecialistunderstandingthatextendsacademicandprofessionalknowledgeandcompetencesgainedthroughBachelordegree8.Demonstratescomprehensiveunderstandingofresearchworkinnursingscienceandthereforebecapableofparticipatinginresearch.9.Demonstratespracticalinsightintotheimplicationsandapplicationsofresearchandevidencebasedpracticetounderpinpracticeforpatientbenefit(researchethics,governance,audit).Dimension2:Nursingpracticeandclinicaldecisionmakingcompetences10.Demonstratestheabilitytoundertakeadvancedandsystematicassessmentsusingthetools/frameworksappropriatetothepatienttakingintoaccountrelevantphysical,social,cultural,psychological,spiritualandenvironmentfactors.11.Demonstratestheabilitytoinitiate,completeand/orsuperviseaneffectiveriskassessmentandtakeappropriateactionssafelyandefficientlyatanadvancedlevel.12.Demonstratestheabilitytorecogniseandinterpretsignsofnormalandchanginghealth/illhealth,distress,ordisabilityintheperson(assessment/diagnosis)andtakeappropriateactionsafelyandefficiently.13.Demonstratestheabilitytomanagepatientneedsbyplanning,deliveringandevaluatingappropriateandindividualisedprogrammesofcareworkinginpartnershipwiththepatient,theircarers,familiesandotherhealth/socialcareprofessionals.14.Demonstratestheabilitytocriticallyquestion,evaluate,interpretandsynthesisecomplexinformationanddatasourcestofacilitatepatientchoice.15.Demonstratestheabilitytomakeevidencebasedclinicaljudgementstoensureoptimumcareandoutcomesforpatients

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16.Demonstratestheabilitytousemoderntechnologiestoassess,manageandrespondappropriatelytopatientneed(forexamplethroughtelenursing,multimediaandwebresources).17.Demonstratestheabilitytouseeffectivelyandefficientlyarangeofnurseskills,medicaldevicesandinterventions/activitiestoensureoptimumcareandoutcomesforpatients.18.Demonstratestheabilitytomaintainandpromotepatientdignity,advocacyandconfidentiality,usingnursingskills,medicaldevicesandinterventions/activitiestoprovideoptimumpatientcare,19.Demonstratestheabilitytopracticeandpromoteprinciplesofhealthandsafetyforselfandotherstoensureoptimumcare,includingmovingandhandling,infectioncontrol;essentialfirstaidandemergencyprocedures,20.Demonstratestheabilitytosafelyadministermedicinesandothertherapieseffectively.21.Demonstratestheabilitytoassessandmanagetheemotional,physicalandpersonalcareneedsofpatients,includingmeetingtheneedforcomfort,nutrition,personalhygieneandenablingthepersontomaintaintheactivitiesnecessaryfordailylife.22.Demonstratestheabilitytoassessandmanagepatientneedthroughoutthelifespanandhealth/illnessexperiencee.g.pain,lifechoices,revalidation,invalidityorwhendying.23.Demonstratestheabilitytoinform,educateandsupervisepatient/carersandtheirfamiliestoensureoptimumcareandoutcomes.24.Demonstratestheabilitytomakeandjustifydecisionsreflectingonsocialandethicalresponsibilitiesaswellasnursingandnursingscienceissuesand,whereappropriate,carryoutanalysisthatresultsinanadequatebasisfordecision-making25.Demonstratestheabilitytocomprehend,analyseandevaluatedevelopmentworkbasedonscholarly,theoreticaland/orexperimentalmethodsinnursingandnursingscience

Dimension3:Knowledgeandcognitivecompetences

27.Demonstratesadvancedknowledgeandunderstandingofthetheoriesofnursingandnursingsciencethatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.28.Demonstratesadvancedknowledgeandunderstandingoftheoriesconcerningthenatureandchallengeofprofessionalpracticethatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.29.Demonstratestheabilitytoanalyse,synthesiseandevaluatethenaturalandlifesciencesthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.30.Demonstratestheabilitytoanalyse,synthesiseandevaluatethesocial,healthandbehaviouralsciencesthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.31.Demonstratesadvancedknowledgeandunderstandingofethicaltheory,lawandhumanitiesthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.32.Demonstratestheabilitytoanalyse,synthesiseandevaluateuseoftechnologyandhealthcareinformaticsthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.33.Demonstratesadvancedknowledgeandunderstandingofinternationalandnationalpoliciesthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.

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34.Demonstratestheabilitytoanalyse,synthesiseandevaluateadvancedknowledgeandunderstandingofproblemsolving,decisionmakingandconflicttheoriesthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.35.Demonstratesadvancedknowledgeandunderstandingoftheoriesrelatedtopersonalandprofessionaldevelopmenttoenhanceownprofessionalpractice.36.Demonstratesadvancedknowledgeandunderstandingoftheresearchprocessandcurrentnursingresearchthatcanbeappropriatelyappliedtonursingpractice,patientcareandsituationsofuncertainty.37.Demonstratestheabilitytocommunicatecomplexprofessionalandacademicissuesinnursingandnursingsciencetobothspecialistsandlaypeopleinaclearandunambiguousmanner.

38.Demonstratestheabilitytoformulateandanalysecomplexscholarlyissuesinnursingandnursingscienceindependently,systematicallyandcriticallyintherelevantspecialisation39.Demonstratestheabilitytocontinueowncompetencydevelopmentandspecialisationinamannerthatmaybelargelyself-directedorautonomousDimension4:Communicationandinterpersonalcompetences(includingtechnologyfor

communication)40.Demonstratestheabilitytocommunicateeffectively(includingtheuseofnewtechnologies)withpatients,familiesandsocialgroups,includingthosewithcommunicationdifficultiestoensureoptimumcareandoutcomesforpatients.41.Demonstratestheabilitytoenablepatientsandtheircarerstoexpresstheirconcernsandworriesandrespondappropriatelyandcollaboratively(e.g.emotional,social,psychological,spiritualorphysicalworries)toensureoptimumcareandoutcomesforpatients.42.Demonstratestheabilitytoappropriatelyidentifyandrepresentthepatient'sperspectiveandacttopreventabusetoensureoptimumcareandoutcomesforpatients.43.Demonstratestheabilitytoappropriatelyuseadvancedcounsellingskillstopromotepatientwellbeingtoensureoptimumcareandoutcomesforpatients.44.Demonstratestheabilitytoidentifyandmanagechallengingbehaviour(usingadvancedcommunicationtechniquestopromotepatientwellbeing)toensureoptimumcareandoutcomesforpatients.45.Demonstratestheabilitytorecogniseandmanageappropriatelyanxiety,stressanddepression(usingadvancedcommunicationtechniquestopromotepatientwellbeing)toensureoptimumcareandoutcomesforpatients.46.Demonstratestheabilitytogiveeffectiveemotionalsupportandidentifywhenspecialistcounsellingorotherinterventionsareneededtoensureoptimumcareandoutcomesforpatients.47.Demonstratestheabilitytoidentifyanduseopportunitiesforhealthpromotionandhealtheducationactivitiesatanadvancedleveltoensureoptimumoutcomesforpatients.48.Demonstratestheabilitytoaccuratelyreport,recordanddocumentcareusingappropriateadvancedtechnologiesandmakereferralswhenneededtoensureoptimumcareandoutcomesforpatients.

Dimension5:Leadership,managementandteamcompetences49.Demonstratestheabilitytocollaborateeffectivelywithallmembersofthehealth/socialcareteamtoensureoptimumcareandoutcomesforpatients.50.Demonstratestheabilitytoleadandco-ordinateteamd,delegatingappropriatelyandmeaningfullytoensureoptimumcareandoutcomesforpatients.

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51.Demonstratestheabilitytowork,influenceandcommunicatecollaborativelyandeffectivelywithothernurses,healthprofessionals,policymakers,andotheractorsinthepublicspace,toensureoptimumcareandoutcomesforpatients.52.Demonstratesabilitytoworkandcommunicatecollaborativelywithallsupportstafftomanageresourceseffectivelywhilemaintainingqualitystandardstoensureoptimumcareandoutcomesforpatients.53.Demonstratestheabilitytoassessriskandactivelypromotethewell-being,securityandsafetyofallpeopleintheworkingenvironment(includingthemselves).54.Demonstratestheabilitytocriticallyassess,developsandusetoolstoevaluateandauditcareaccordingtorelevantclinicalguidelinesandqualitystandards.55.Demonstratestheabilitytoeducate,facilitate,superviseandsupportnursingstudentsandotherhealth/socialcarestudentsorworkersintheclinicalenvironment.56.Demonstratestheabilitytoapplyandinfluenceofhealth/socialcarefundingstreamsanduseresourceseffectively.

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Appendix3:RelevantChangesfromDirective2005/36/ECto2013/55/EC(itemsinbold)

(18) Directive2005/36/ECshould,throughtheintroductionofcommontrainingprinciples,promoteamoreautomaticcharacterofrecognitionofprofessionalqualificationsforthoseprofessionswhichdonotcurrentlybenefitfromit.ThisshouldtakeaccountofthecompetenceofMemberStatestodecidetheprofessionalqualificationsrequiredforthepursuitofprofessionsintheirterritoryaswellasthecontentsandtheorganisationoftheirsystemsofeducationandtraining.Commontrainingprinciplesshouldtaketheformofcommontrainingframeworksbasedonacommonsetofknowledge,skillsandcompetencesorcommontrainingtests.ItshouldbepossibleforcommontrainingframeworksalsotocoverspecialtiesthatcurrentlydonotbenefitfromautomaticrecognitionprovisionsunderDirective2005/36/ECandthatrelatetoprofessionsencompassedbyChapterIIIofTitleIIIandthathaveclearlydefinedspecificactivitiesreservedtothem.Commontrainingframeworksonsuchspecialties,inparticularmedicalspecialties,shouldofferahighlevelofpublichealthandpatientsafety.

22) Article31isamendedasfollows:(a) paragraph1isreplacedbythefollowing:“1. Admissiontotrainingfornursesresponsibleforgeneralcareshallbecontingentuponeither:

(a) completionofgeneraleducationof12years,asattestedbyadiploma,certificateorotherevidenceissuedbythecompetentauthoritiesorbodiesinaMemberStateoracertificateattestingsuccessinanexaminationofanequivalentlevelandgivingaccesstouniversitiesortohighereducationinstitutionsofalevelrecognisedasequivalent;or

(b) completionofgeneraleducationofatleast10years,asattestedbyadiploma,certificateorotherevidenceissuedbythecompetentauthoritiesorbodiesinaMemberStateoracertificateattestingsuccessinanexaminationofanequivalentlevelandgivingaccesstoavocationalschoolorvocationaltrainingprogrammefornursing.”;

(c) inparagraph3,thefirstsubparagraphisreplacedbythefollowing:

“Thetrainingofnursesresponsibleforgeneralcareshallcompriseatotalofatleastthreeyearsofstudy,whichmayinadditionbeexpressedwiththeequivalentECTScredits,andshallconsistofatleast4600hoursoftheoreticalandclinicaltraining,thedurationofthetheoreticaltrainingrepresentingatleastonethirdandthedurationoftheclinicaltrainingatleastonehalfoftheminimumdurationofthetraining.MemberStatesmaygrantpartialexemptionstoprofessionalswhohavereceivedpartoftheirtrainingoncourseswhichareofatleastanequivalentlevel.”;

(ca) paragraph4isreplacedbythefollowing:“4. Theoreticaleducationisthatpartofnursetrainingfromwhich

traineenursesacquiretheprofessionalknowledge,skillsandcompetencesrequiredunderparagraphs6and7.Thetrainingshallbegivenbyteachersofnursingcareandbyothercompetentpersons,atuniversities,highereducationinstitutionsofalevelrecognisedasequivalentoratvocational

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schoolsorthroughvocationaltrainingprogrammesfornursing.”;

(cb) inparagraph5,thefirstsubparagraphisreplacedbythefollowing:“5. Clinicaltrainingisthatpartofnursetraininginwhichtrainee

nurseslearn,aspartofateamandindirectcontactwithahealthyorsickindividualand/orcommunity,toorganise,dispenseandevaluatetherequiredcomprehensivenursingcare,onthebasisoftheknowledge,skillsandcompetenceswhichtheyhaveacquired.Thetraineenurseshalllearnnotonlyhowtoworkinateam,butalsohowtoleadateamandorganiseoverallnursingcare,includinghealtheducationforindividualsandsmallgroups,withinhealthinstitutesorinthecommunity.”;

(cc) paragraph6isreplacedbythefollowing:“6. Trainingfornursesresponsibleforgeneralcareshallprovide

anassurancethattheprofessionalinquestionhasacquiredthefollowingknowledgeandskills:(a) comprehensiveknowledgeofthesciencesonwhich

generalnursingisbased,includingsufficientunderstandingofthestructure,physiologicalfunctionsandbehaviourofhealthyandsickpersons,andoftherelationshipbetweenthestateofhealthandthephysicalandsocialenvironmentofthehumanbeing;

(b) knowledgeofthenatureandethicsoftheprofessionandofthegeneralprinciplesofhealthandnursing;

(c) adequateclinicalexperience;suchexperience,whichshouldbeselectedforitstrainingvalue,shouldbegainedunderthesupervisionofqualifiednursingstaffandinplaceswherethenumberofqualifiedstaffandequipmentareappropriateforthenursingcareofthepatient;(d) theabilitytoparticipateinthepracticaltrainingofhealthpersonnelandexperienceofworkingwithsuchpersonnel;

(e) experienceofworkingtogetherwithmembersofotherprofessionsinthehealthsector.”;

(d) thefollowingparagraphisadded:“7. Formalqualificationsasanurseresponsibleforgeneralcare

shallprovideevidencethattheprofessionalinquestionisabletoapplyatleastthefollowingcompetencesregardlessofwhetherthetrainingtookplaceatuniversities,highereducationinstitutionsofalevelrecognisedasequivalentoratvocationalschoolsorthroughvocationaltrainingprogrammesfornursing:(a) competencetoindependentlydiagnosethenursingcare

requiredusingcurrenttheoreticalandclinicalknowledgeandtoplan,organiseandimplementnursingcarewhentreatingpatientsonthebasisoftheknowledgeandskillsacquiredinaccordancewithpoints(a),(b)and(c)ofparagraph6inordertoimproveprofessionalpractice;

(b) competencetoworktogethereffectivelywithotheractorsinthehealthsector,includingparticipationinthepracticaltrainingofhealthpersonnelonthebasisoftheknowledgeandskillsacquiredinaccordancewithpoints(d)and(e)ofparagraph6;

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(c) competencetoempowerindividuals,familiesandgroupstowardshealthylifestylesandself-careonthebasisoftheknowledgeandskillsacquiredinaccordancewithpoints(a)and(b)ofparagraph6;

(d) competencetoindependentlyinitiatelife-preservingimmediatemeasuresandtocarryoutmeasuresincrisesanddisastersituations;

(e) competencetoindependentlygiveadviceto,instructandsupportpersonsneedingcareandtheirattachmentfigures;

(f) competencetoindependentlyassurethequalityof,andtoevaluate,nursingcare;

(g) competencetocomprehensivelycommunicateprofessionallyandtocooperatewithmembersofotherprofessionsinthehealthsector;

(h) competencetoanalysethecarequalitytoimprovehisownprofessionalpracticeasanurseresponsibleforgeneralcare.”.

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Appendix4.ListofthefirstSubjectAreaGroupforNursing(SAG1)

Theworkinggroupwasco-ordinatedbyMaryGobbi,whohaseditedthebrochure.TheSAGmembersbelowhaveallcontributedtotheconstructionofthebrochure1stedition.Co-coordinatorUnitedKingdomMaryGobbiFacultyofHealthSciencesUniversityofSouthampton–Southamptonmog1@soton.ac.uk

InnerCircleBelgiumUniversityCollegeofArteveldehoheschoolLilyDeVlieger(Deceased,rememberedwithgreataffectionandrespect)

GhentUniversityAssociationFrederikDeDeckerFrederik.DeDecker@AuGent.be

DenmarkVIAUniversityCollege,FacultyofHealthSciencesInger-MargretheJensenimj@viauc.dk

FinlandSchoolofHealthSciencesFacultyofSocialSciencesUniversityofTampere–TampereMarjaKaunonenmarja.kaunonen@uta.fi

FinlandUniversityofKuopioHeikkiPekkarinen(Deceased,rememberedwithgreataffectionandrespect)

GermanyAliceSalomonUniversityofAppliedSciencesBerlinIngridKollakKollak@asfh-berlin.de

HungarySemmelweisUniversityBudapestSandorHollosholloss@se-etk.hu

IrelandWaterfordInstituteofTechnologyClareWalshctwalsh@wit.ie

MaltaInstituteofHealthCareUniversityofMaltaGraceJaccarini(to2008)grace.a.jaccarini@um.edu.mtDoniaBaldacchino(from2008)donia.balcacchino@um.edu.mt

TheNetherlandsHanzeUniversityofGroningenUniversityofAppliedSciencesSchoolofNursingMaartenM.Kaaijikm.m.kaaijk@pl.hanze.nl

NorwayAgderUniversityCollegeBjorgDale(to2008)bjorg.dale@hia.no

SlovakiaComeniusUniversityMartinPeterGalajdagalajda@jfmed.uniba.sk

SpainUniversidaddeZaragozaDepartamentoEnfermería–NursingConchaGermánBescgerman@unizar.es

UkraineBogomoletsMedicalUniversity/TestingBoard(ofprofessionalcompetenceassessment)attheMinistryofPublicHealthofUkraineMarinaMrougaandIrynaBulakhmrouga@testcentr.org.uabulakh@testcentr.org.ua

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ContactsTheTuningProjects,includingCALOHEE,areco-ordinatedbytheUniversityofDeusto,Bilbao,SpainandtheUniversityofGroningen,TheNetherlands.GeneralCo-ordinatorsRobertWagenaarDirectorInternationalTuningAcademyUniversityofGroningenr.wagenaar@rug.nl

PabloBeneitoneDirectorInternationalTuningAcademyDeustoUniversity,Bilbaopablo.beneitone@deusto.es

ContactsIngridvanderMeerProjectManagerInternationalTuningAcademyFacultyofArtsUniversityofGroningenP.O.Box7169700ASGroningenTheNetherlandsTel.:+31503636059y.van.der.meer@rug.nl

VisittheTuningwebsitesformoreinformation:

Ø InternationalTuningAcademy: http://tuningacademy.orgØ TuningEurope: