Development of competencies aimed at client-centred care: an evaluation study

The aim of this study was to evaluate a learning programme for Dutch community nurses and auxiliary nurses aimed at the development of competencies with respect to client-centred care for chronically ill clients. The study was guided by the Kessels's Eight-fields model. Several stakeholders, including clients, participated in the development, execution and evaluation of the programme. The concept of client-centred care, client goals and competencies for nurses were identified systematically. Competencies identified were a care-process in dialogue, enabling client participation and dealing with tensions. Principles of development of competencies were applied in the design of learning activities. The programme was evaluated at three levels: learning processes; performance of competencies in practice; and perceived client-centredness by clients. Three home-care organizations were involved in the evaluation study. In total, 175 employees participated in the basic module and 34 nurses and auxiliary nurses participated in the advanced module. In total, 107 chronically ill clients were involved in the study, of which 50 in the evaluation group and 57 in a group checking for selection bias. Findings indicate a positive impact on two of the evaluation levels: learning processes and the performance of nurse's competencies in practice. No statistical impact was found on clients 2 months after the end of the programme. The process evaluation provided knowledge concerning pre-conditions for learning processes and performance of competencies in practice. The study concludes that it seems that a change towards client-centred care has been initiated. Client-centred care encompasses more, however, than competence development in individual nurses. A corporate approach is recommended, encompassing the support of the primary process of client-centred care by the entire care organization. Further research aimed at the implementation of client-centred care is recommended.