Article 3 Sec.9 (c) of R.A.

9173/ Philippine Nursing Act 2002 Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation. Four stages of competence In psychology, the four stages of competence, or the "conscious competence" learning model, relates to the psychological states involved in the process of progressing from incompetence to competence in a skill. History Initially described as Four Stages for Learning Any New Skill, the theory was developed at theGordon Training International by its employee Noel Burch in the 1970s.[1] It has since been frequently attributed to Abraham Maslow, although the model does not appear in his major works.[2] The Four Stages of Learning provides a model for learning. It suggests that individuals are initially unaware of how little they know, or unconscious of their incompetence. As they recognize their incompetence, they consciously acquire a skill, then consciously use it. Eventually, the skill can be utilized without it being consciously thought through: the individual is said to have then acquired unconscious competence. [3] Several elements, including helping someone 'know what they don't know' or recognize a blind spot, can be compared to some elements of a Johari window, although Johari deals with self-awareness, while the four stages of competence deals with learning stages. The four stages Unconscious incompetence (You don't know that you can't do it well) The individual does not understand or know how to do something and does not necessarily recognize the deficit. They may deny the usefulness of the skill. The individual must recognise their own incompetence, and the value of the new skill, before moving on to the next stage.[2] The length of time an individual spends in this stage depends on the strength of the stimulus to learn.[3] Conscious incompetence (You know you can't do it well.) Though the individual does not understand or know how to do something, he or she does recognize the deficit, as well as the value of a new skill in addressing the deficit. The making of mistakes can be integral to the learning process at this stage.[4]

Conscious competence (You do it well, and you think about the work as you do it.) The individual understands or knows how to do something. However, demonstrating the skill or knowledge requires concentration. It may be broken down into steps, and there is heavy conscious involvement in executing the new skill.[3] Unconscious competence (You're so successful it's "automatic" -- you do it well, without thinking about it.) The individual has had so much practice with a skill that it has become "second nature" and can be performed easily. As a result, the skill can be performed while executing another task. The individual may be able to teach it to others, depending upon how and when it was learned. The four-stage model is intriguingly simple, describing a person's path from ignorance to mastery: Stage 1: Unconscious Incompetence This is where our person starts. They are pretty bad at what they are trying to do, however, they are completely unaware of how bad they are. In fact, in many cases, the unconsciously incompetent person actually thinks they are pretty good at it, which gets in the way of them improving. Stage 2: Conscious Incompetence Our person has now realized there is much more to what they are trying to do than they realized, and they don't really know what they thought they knew. In this stage, the consciously incompetent individual may become overwhelmed by what seems to be a vast knowledge area they can't quite grasp. Stage 3: Conscious Competence Here our person has overcome what they didn't know and started the path of learning. The consciously competent person executes their tasks much more successfully, but the focus and attention it requires has the price of being slow. Stage 4: Unconscious Competence In this final stage, our person has now internalized all the knowledge and can utilize their understanding without active thought or concentration. The unconsciously competent person completes the tasks with grace and speed. Fifth stage The model is expanded by some users to include a fifth stage, which is not part of the original model from Gordon Training International. The exact composition of this stage varies between authors. Some

refer to reflective ability, or "conscious competence of unconscious competence", as being the fifth stage, while others use the fifth stage to indicate complacency.[2]

The Four Stages of Learning The learning process has often become more difficult than necessary because of the bad feelings people get when they make mistakes in learning. The bad feelings come from judgments like, "not doing it right," "not good enough," "can never learn this," etc. Ironically, not doing it right and making mistakes are vital steps in the learning process. Yet too often our attention goes to trying to avoid the bad feelings, rather than to the learning at hand. Understanding the four stages of learning a skill can help keep the learning process focused on learning to do something, and not feeling bad about ourselves for not already knowing how. Here are the four stages of learning as uncovered by Abraham Maslow: 1. Unconscious Incompetence "I don't know that I don't know how to do this." This is the stage of blissful ignorance before learning begins. 2. Conscious Incompetence "I know that I don't know how to do this, yet." This is the most difficult stage, where learning begins, and where the most judgments against self are formed. This is also the stage that most people give up. 3. Conscious Competence "I know that I know how to do this." This stage of learning is much easier than the second stage, but it is still a bit uncomfortable and self-conscious. 4. Unconscious Competence "What, you say I did something well?" The final stage of learning a skill is when it has become a natural part of us; we don't have to think about it. Using the example of learning to drive a car, as a child I first thought that all I needed to do was sit behind the wheel and steer and use the pedals. This was the happy stage of unconscious incompetence. When I began learning to drive, I realized there was a whole lot more to it, and I became a little daunted. This was the stage of conscious incompetence. There were so many different things to do and

think about, literally hundreds of new behaviors to learn. In this stage I made lots of mistakes, along with judgments against myself for not already knowing how to do it. Judgment release can be very helpful here in the second stage because mistakes are integral to the learning process. They're necessary because learning is essentially experimental and experiencebased, trial and error. Information can be accumulated, but until it is practiced and used, it's only information. It's not learning, and certainly not a skill. As I practiced, I moved into the third stage of learning, conscious competence. This felt a lot better, but still I wasn't very smooth or fluid in my driving. I often had to think about what to do next, and that felt awkward and uncomfortable. Finally, after enough practice, I got to the place where I didn't have to think about every little thing I was doing while driving. I thought about my driving only when something alerted me to it. I became unconsciously competent. Because of the ease and grace in unconscious competence, my driving became much safer.

Before rolling out specific training or initiatives that are aimed at improving some facet of your business, you need to ensure that your leaders and team members are equipped with fundamental communication and relationship management skills. Numerous studies have verified that cooperation, communication, interpersonal skills, listening and summarizing skills are critical to higher-order team success. In their book, The Leadership Challenge, Kouzes and Posner write, Every leader ought to know how to paraphrase, summarize, express feelings, disclose personal information, admit mistakes, respond non-defensively, ask for clarification, solicit different views, and so on. These skills are at the heart of emotional intelligence. Cultivating them in managers and employees is the key to all of the benefits of training and development. An organization that is already able to communicate across levels productively and functionally, and to manage conflicts creatively and beneficially, is prepared for higher-order training and learning that will require those skills for successful implementation. The Four Stages for Learning Any New Skill No matter what new skill we decide to learn, there are four learning stages* each of us goes through. Being aware of these stages helps us better accept that learning can be a slow and frequently uncomfortable process. Stage 1 Unconsciously unskilled. We dont know what we dont know. We are inept and unaware of it.

Using a recent personal example, last year after seeing the great shape a friend was in and learning that it was a result of Pilates exercise, I decided to try it out for myself. The first time I went to a class, I felt self-conscious and awkward. I knew nothing about how Pilates worked and I had never seen, much less used, any of those machines before. Applying this principle to communication training at work, often leaders communicate in ways that interfere with or damage relationships with their team members, but they arent aware of it. Stage 2 Consciously unskilled. We know what we dont know. We start to learn at this level when sudden awareness of how poorly we do something shows us how much we need to learn. I have exercised for many years so I thought I was already pretty fit and strong. Wrong. After two or three Pilates classes, I was struck by how few of the movements I could do well. The instructor did a lot of observing and correcting. I also observed the ease with which she and other students did more advanced movements (and learned how long theyve been doing it!). While participating in a Leader Effectiveness Training course, leaders become aware of both ineffective and effective ways of communicating. They become conscious of the way most of us usually respond when team members signal they have a problem and the negative effects these Roadblocks have on the working relationship. And they become aware of the power of empathic listening. They also learn about the importance of clear and direct self-disclosure as an alternative to passive or aggressive communication. But at this stage, they arent yet using these skills. They might feel some guilt as they realize the effects their previous communication might have had on their team members. Stage 3 Consciously skilled. Trying the skill out, experimenting, practicing. We now know how to do the skill the right way, but need to think and work hard to do it. In each Pilates class, I try to concentrate completely on doing the movements correctlyboth to get the most benefit from them and to avoid getting corrected. Its not easy because Im not used to these positions and havent yet developed the core strength it takes to do them well. Its invaluable to have an instructor there to coach and help me get it right. At this stage of learning communication skills, leaders are very conscious of using them. They try hard to avoid unhelpful or damaging responses and to listen empathically instead. This means they bite their tongue a lot! And they are very aware of trying to speak in clear, authentic, non-blameful language when expressing their opinions, needs and problems. When conflicts arise, their goal is to try to find a solution that works for both people. Sometimes, they might feel a little phonythe use of skills seems kind of gimmicky. Other people usually perceive the leader as consciously trying to communicate differently. Stage 4 Unconsciously skilled. If we continue to practice and apply the new skills, eventually we arrive at a stage where they become easier, and given time, even natural. Now, nine months later, after going to Pilates twice each week, I can do many more moves and no longer feel so awkward. I look forward to going to the classes; theyre energizing, challenging and

rewarding, and no longer scary. Ive gotten stronger and more fit and other people notice the difference, too! Still, I see how far I have to go. When leaders persist in using the skills they start to be comfortable with them. Now active listening, congruent self-disclosure and no-lose conflict resolution seem more natural. Team members and others respond favorably because they feel heard, understood, appreciated, satisfied. Leaders find that they can apply these skills in all areas of their lives and gradually they become integrated into all of their interactions and become the natural way of being with others.

The C- Theory
INTRODUCTION
The image of nursing is changing. Images of angels in starched skirts and nursing caps eagerly awaiting guidance from physicians has long since been replaced by images of competent, independent men and women of diverse backgrounds. Gordon (2005) described the historical, stereotypical (iconic) view of the nurse as that of a physicians handmaiden, dependent on the physician for direction. She explained that the nursing profession has been negligent in sharing with the public the importance of nurses critical thinking, problem-solving, and research skills. Nurses have failed to help the public understand that nurses actions involve more than nurturing; they also include assessing, surveying for risks, identifying client goals, planning independent actions, and prioritizing care. Gordon (2006) has stated that in order to gain and maintain the respect of the public and other healthcare professionals, nurses must emphasize and communicate the knowledge and skills required for professional nursing. It is also imperative that those responsible for reimbursement of nursing care understand that nurses save lives, prevent complications, prevent suffering, and save money (para. 5). OMara (1999) has argued that in order to assure reimbursement and access to needed resources nurses need to articulate the cognitive abilities nurses need in order to provide competent care. Benner, Sutphen, Leonard, and Day (2010), too, have written that nurses must learn to emphasize the tangible benefits of nurses, beyond that of caring. Nurses must overwhelmingly acknowledged Learning as a major factor in nursing competence. The importance of the Learning process in nursing indicates that knowledge and Skills are required to prevent untoward patient outcomes. It also identified competence as prerequisite to establishing trust with others. Competence is important because, it makes patients want you to take care of them and patients and health professionals trust competent nurses. And competence addresses patients holistically - in all dimensions. But the learning process has often become more difficult than necessary because of the bad feelings people get when they make mistakes in learning. The bad feelings come from judgments like, "not doing it right," "not good enough," "can never learn this," etc. Ironically, not doing it right and making mistakes are vital steps in the learning process. Yet too often our attention goes to trying to avoid the bad feelings, rather than to the learning at hand. Understanding the stages of learning a skill can help keep the learning process focused on learning to do something, and not feeling bad about ourselves for not already knowing how. II It has since been frequently attributed to Abraham Maslow, The Four Stages of Learning, provides a model for learning. It suggests that individuals are initially unaware of how little they know, or unconscious of their incompetence. As they recognize their incompetence, they consciously acquire a skill then consciously use it.

Eventually, the skill can be utilized without it being consciously thought through: the individual is said to have then acquired unconscious competence. Assumptions

Learning and practice partnerships are key to developing an effective model.

o o o

An integrated practice/learning competency model will positively impact patient safety and improve patient care Nursing practice should be differentiated according to the nurses educational preparation and level of practice and further defined by the role of the nurse and the work setting Practice environments that support and enhance professional competence are essential

The nurse of the future will be proficient in a core set of competencies.

o o
Model

There is a differentiation in competencies among practicing nurses at various levels Competence is developed over a continuum and can be measured

Stage 1 Unconsciously unskilled. We dont know what we dont know. We are inept and unaware of it. Using a recent personal example, last year after seeing the great shape a friend was in and learning that it was a result of Pilates exercise, I decided to try it out for myself. The first time I went to a class, I felt self-conscious and awkward. I knew nothing about how Pilates worked and I had never seen, much less used, any of those machines before. Applying this principle to communication training at work, often leaders communicate in ways that interfere with or damage relationships with their team members, but they arent aware of it. Stage 2 Consciously unskilled. We know what we dont know. We start to learn at this level when sudden awareness of how poorly we do something shows us how much we need to learn. I have exercised for many years so I thought I was already pretty fit and strong. Wrong. After two or three Pilates classes, I was struck by how few of the movements I could do well. The instructor did a lot of observing and correcting. I also observed the ease with which she and other students did more advanced movements (and learned how long theyve been doing it!). While participating in a Leader Effectiveness Training course, leaders become aware of both ineffective and effective ways of communicating. They become conscious of the way most of us usually respond when team members signal they have a problem and the negative effects these Roadblocks have on the working relationship. And they become aware of the power of empathic listening. They also learn about the importance of clear and direct self-disclosure as an alternative to passive or aggressive communication. But at this stage, they arent yet using these skills. They might feel some guilt as they realize the effects their previous communication might have had on their team members.

Stage 3 Consciously skilled. Trying the skill out, experimenting, practicing. We now know how to do the skill the right way, but need to think and work hard to do it. In each Pilates class, I try to concentrate completely on doing the movements correctlyboth to get the most benefit from them and to avoid getting corrected. Its not easy because Im not used to these positions and havent yet developed the core strength it takes to do them well. Its invaluable to have an instructor there to coach and help me get it right. At this stage of learning communication skills, leaders are very conscious of using them. They try hard to avoid unhelpful or damaging responses and to listen empathically instead. This means they bite their tongue a lot! And they are very aware of trying to speak in clear, authentic, non-blameful language when expressing their opinions, needs and problems. When conflicts arise, their goal is to try to find a solution that works for both people. Sometimes, they might feel a little phonythe use of skills seems kind of gimmicky. Other people usually perceive the leader as consciously trying to communicate differently. Stage 4 Unconsciously skilled. If we continue to practice and apply the new skills, eventually we arrive at a stage where they become easier, and given time, even natural. Now, nine months later, after going to Pilates twice each week, I can do many more moves and no longer feel so awkward. I look forward to going to the classes; theyre energizing, challenging and rewarding, and no longer scary. Ive gotten stronger and more fit and other people notice the difference, too! Still, I see how far I have to go. When leaders persist in using the skills they start to be comfortable with them. Now active listening, congruent self-disclosure and no-lose conflict resolution seem more natural. Team members and others respond favorably because they feel heard, understood, appreciated, satisfied. Leaders find that they can apply these skills in all areas of their lives and gradually they become integrated into all of their interactions and become the natural way of being with others.

Concepts and definitions Competence - addresses patients holistically - in all dimensions.