As so aptly described by Novack et al (1997) in the medical education literature, and Benner (2000) in human nursing, practitioners learn the science of their discipline, but ‘use themselves to practice its art’. This description also very accurately encapsulates the concept of professional competence for the veterinary nurse. Professional competence involves engaging the three domains of learning, i.e. the cognitive (acquiring knowledge and problem solving), the affective (concerned with emotions) and the technical (being able to perform technical procedures) domains (as in Bloom's taxonomy). The affective domain involves attributes relating to emotional intelligence or what can also be referred to as personal attributes. There has been limited research in the veterinary nursing field to date regarding personal attributes or emotional intelligence and professional competence. Therefore, at this point we must rely on research that has been undertaken in other practicebased professions such as the veterinary, health and medical sciences (Radford, 2003; Burns et al, 2006; Lloyd, 2007; Turnwald et al, 2008).
In the medical education literature, professional competence has been more explicitly described as the habitual and skilful use of communication, knowledge, technical skills, problem-solving ability, emotions, values and reflection in the practice of medicine for the benefit of the patient and the community being served (Epstein and Hundert, 2002). This definition supports a model of professional competence that integrates the three domains of learning and is very pertinent in characterizing the professional competence of the veterinary nurse today.
Challenges for veterinary nurses today are similar to those of the veterinarian and include changing societal needs and expectations (Brown and Silverman, 1999; Willis et al, 2007) which impact on the level and quality of veterinary services required (Rubin, 2003). Clients are more informed, discerning and bonded to their pets than in previous times (Brown and Silverman, 1999). Additionally, employers have high expectations not only of the veterinary nurse's technical skills but also of their personal attributes (Ruby and DeBowes, 2007). The veterinary nurse must be educated to meet these challenges and veterinary nursing curricula are being shaped to prepare veterinary nurses for their complex professional role. This article will explore the nature of veterinary nurses' professional competence, particularly the importance of personal attributes, as well as examine models from other disciplines. The implications this has for veterinary nursing curricula will also be discussed.
Personal attributes and professional relationships
The veterinary client
The veterinary nurse's role in providing client services has advanced dramatically over the past 30 years and will continue to expand as veterinary practices increasingly take advantage of the veterinary nurse's highly developed skills. In many countries throughout the world, there is a move for veterinary nurses to become more involved in nurse consultations or clinics in areas such as nutrition, wellness and behaviour and training (Jervring, 1993; Landsberg et al, 2008). Veterinary nurses also play a pivotal role in client education generally. Along with trends in other caring professions such as human nursing, societal expectations of the veterinary nurse have changed rapidly. Similar to human nurses, veterinary nurses now service a more educated and empowered client who has access to the worldwide web and possesses a heightened awareness of his or her rights as a consumer (Hegarty et al, 2009). In response to this both human nurses and veterinary nurses must ‘respect, affirm and share decision making with increasingly knowledgeable’ [clients] (Hegarty et al, 2009). Berkow (2002) has also reported in the human nursing literature that personal attributes are what enable a nurse to communicate respectfully with patients and to determine their primary concerns; to practise the art of nursing (Wilson, 2005). This would also be true for veterinary nurses and the veterinary client. Therefore, to adequately equip veterinary nurses to meet the needs of the client of today, educating for the development of personal or emotional intelligence attributes is vital.
‘Professional competence involves commitment to lifelong learning by keeping up to date with the latest developments in the field of veterinary nursing. Maintaining a record of CPD is an essential part of that commitment. ’
Another factor associated with the importance of personal attributes as part of the veterinary nurse's professional competence is the increasing recognition of the relationships that clients have with their pets. The importance of the human-animal bond (HAB) is evident in its emergence in the veterinary literature and its inclusion in veterinary curricula (Brown and Silverman, 1999; Shaw, 2006). Clients often view their pets as family members and recognition of the HAB by veterinarians has been linked to clients' positive perceptions of the veterinary practice and its success as a business (Brown and Silverman, 1999; Timmins, 2008). Therefore, in their daily clinical practice, veterinary nurses too must acknowledge the HAB and be sensitive to the client's level of attachment to their pet. It would, therefore, seem to be essential that veterinary nurses, as well as being technically skilled, should also engage the affective domain to competently meet the needs of these increasingly knowledgeable and bonded clients. In support of this, veterinary nursing education in both vocational and higher education programmes, internationally, have integrated studies of the HAB into curricula.
Professional colleagues
In addition to client relationships, the relationships that the veterinary nurse has with his or her professional colleagues in the clinical environment are also very important. Studies in the veterinary literature have demonstrated that personal attributes are valued by employers when hiring veterinary personnel. An Australian study by Heath and Mills (2000) revealed that interpersonal skills and personal qualities, such as being cheerful and self confident, were the most important criteria for veterinary employers in selecting new graduate veterinarians. In addition, an American study by Ruby and DeBowes (2007) in exploring the successful veterinary healthcare team, espoused that veterinary practices should employ staff, not just for their technical competence, but also on the basis of their emotional intelligence. These studies all provide further evidence of the place that personal or emotional intelligence attributes have in defining veterinary nurses' professional competence and their importance in veterinary nursing curricula.
The importance of empathy, caring and sensitivity
In addition to the above studies, the importance of personal attributes in professional competence has been supported in veterinary communications research. Here empathy has been described as the most important skill for veterinarians in building client relationships (Bonvicini, 2008). It has also been reported that clients rate veterinarians' communication skills and the emotional aspects of the veterinarian-client relationship as more important than technical expertise (Tinga et al, 2001). These results could likewise be extrapolated to veterinary nurses who increasingly interact with clients through veterinary nurses' consultations/clinics and associated activities in the veterinary practice and in the wider community. Therefore, if veterinary nurses are to have satisfied clients they must ensure the client experience is a positive one and that their needs, wants and expectations are met (Burge, 2003). It would also appear that for veterinary nurses to achieve this, similar to veterinarians, they must be able to connect with clients emotionally by listening to them and being empathetic when communicating (Bonvicini, 2008). Thus an emphasis on the development of personal attributes such as empathy in veterinary nursing curricula would be of paramount importance. Currently, this is being achieved through communications skills training, a strategy used extensively in the veterinary and medical undergraduate fields (Shaw, 2006). Similarly this is also a feature of many veterinary nursing programmes internationally, at both vocational and higher education level; programmes in the UK, USA and Australia providing examples. However, to date there has been a lack of published research relating to what is happening in the veterinary nursing field.
Self awareness and professional competence
To further develop the personal attributes of caring, sensitivity and empathy it has been reported that a growth in self awareness and management of one's feelings, attitudes and beliefs is required (Kern et al, 2001). Hence, self awareness would be an essential skill in developing personal attributes for veterinary nurses' professional competence. Self awareness has been defined as an ability to pay attention to one's own emotions, attitudes and behaviours and to recognize how these can affect interactions with others (Benbassat and Baumal, 2005). This ability would therefore be very relevant to the veterinary nurse's role when interacting with clients and professional colleagues. Novack et al (1997) also highlighted the influence that conscious and unconscious attitudes, previous life experiences, psychological and cultural backgrounds have on an individual's personal and professional behaviour. Thus, self awareness, in allowing a veterinary nurse to examine personal attitudes and prejudices, would facilitate professional competence and improve interpersonal skills. The importance of these skills for veterinary nurses cannot be underestimated as interpersonal understanding has been identified as one of the most important attributes for human nursing performance (Zhi-Xue et al, 2001). Benner (2000), in the human nursing literature, also highlights the importance of phronesis in nursing practice where nursing work is guided by relatedness and human concerns, not just the technical aspects of nursing. Benner's research also traces the development of a nurse from novice through to competent practitioner, which is marked by an increased capacity to relate. Therefore for veterinary nurses like human nurses where relatedness is important a healthy self awareness would be highly desirable.
From an educational perspective, it is possible to implement pedagogical strategies to enhance self awareness. Novack et al (1997) have described the use of reflection, alone or in groups, to develop this skill. More specifically, methods of developing self awareness that may be used in an educational or clinical context include:
One of the goals of veterinary nursing education should therefore be to assist students to enhance their self awareness by gaining insight into their attitudes, behaviours and emotions through the pedagogical strategies listed above.
Additionally, in an educational context, educators may be proactive in fostering the development of students' self awareness by ‘explicitly modelling their means for cultivating awareness’ (Epstein, 1999, 838). Furthermore, most strategies for developing self awareness incorporate reflective practice to examine and evaluate one's beliefs, attitudes and behaviours. In developing self awareness, it is also beneficial to be aware of barriers that may impede its development such as fatigue, depression, substance abuse, and being close minded. These points may need to be addressed when trying to foster increased self awareness in students.
Implications for veterinary nurse education and research
In the medical literature it has been cited that for many years the acquisition of professional values and behaviours occurred largely through an informal process of socialization during education (Swick et al, 1999). This would have been the case for most professions, including veterinary nurses, and we now know this is not enough to adequately prepare students for the increasing complexity of their professional roles. A range of pedagogical strategies for developing personal attributes important for professional competence can be integrated into curricula. Several have been mentioned previously and others include the use of trigger tapes highlighting desirable attributes such as empathy, family of origin group discussions, encouraging reflection on client interactions from clinical practicum, and achieving balance between personal and professional [student] life (Novack et al, 1999). Educators can also be powerful role models for their students with personal qualities being cited as a critical influencing factor in the choice of role models by medical students (Wright and Carrese, 2002). Similarly, Benner et al (2009) in the nursing literature write of the capacity of educators to model and raise awareness of effective skills of interpersonal engagement for their students.
Again borrowing from the medical education literature, and in support of the material discussed previously, the following goals could provide a framework for educating veterinary nurses for professional competence. Using this framework a curriculum would educate veterinary nursing students to:
These goals recognize the importance of the affective domain and personal attributes in the qualified veterinary nurse; the art of putting part of ‘themselves’ into their professional role.
Conclusion
This article has endeavoured to highlight the importance of personal attributes, from the affective or emotional domain, in defining the veterinary nurse's professional competence. Personal attributes such as caring and empathy, which are integral to the veterinary nurse's professional competence, can be further developed by the skills of reflection and a developing self awareness. In fostering these attributes and skills, veterinary nurse educators have previously drawn on pedagogical strategies used in other disciplines such as medicine and human nursing. Broadening curricula with an increased emphasis on the affective domain of learning will better equip veterinary nursing graduates to meet the expectations of employers and clients in a rapidly changing world. Veterinary nursing education has been very proactive in providing innovative curricula with an emphasis on the human dimension of practice, however, there have been limited research publications on these topics. Thus this could provide an area for further discussion and future research.