Abstract
Background: Having a skilled workforce is essential for the delivery of high quality, integrated home and community care. Home Health Nursing (HHN) Competencies provide a unified understanding of the knowledge, skills and attributes required for safe and ethical care, serving as a resource to support consistency in care delivery across locations of care. However, to be used effectively for workforce training and development, competencies must reflect current evidence and align with the expected skills required for home health nursing practice. This study aimed to identify a set of relevant competencies essential for the delivery of safe and ethical home health nursing in Canada’s contemporary practice environment.
Approach: In 2024, in collaboration with the Community Health Nurses of Canada, a modified eDelphi study was undertaken to update the national home health nursing competencies. An environmental scan of pre-existing home health competencies served as the basis for the eDelphi process. Over three rounds of surveys, a diverse panel of home health nurses (n=43) working across point-of-care, leadership, and education roles provided feedback on the relevance and importance of pre-existing competencies and recommended additional competencies for inclusion. Consultations with interdisciplinary home care team members (n=12) and home health nurses (n=41) were conducted to validate survey results and obtain additional feedback. An Advisory Working Group of home health nursing leaders (n=24) was consulted throughout the study to inform decision-making and endorsed final competency recommendations.
Results: A total of 79 competencies were recommended for inclusion in the updated home health nursing competencies based on feedback from home health nurses, including Registered Nurses, Registered / Licensed Practical Nurses and Nurse Practitioners working in rural and urban areas across 10 provinces and territories in Canada. Newly added competencies highlight the importance of trauma-informed care, clients’ caregivers and social networks, and incorporate concepts based on Canada’s Truth and Reconciliation Calls to Action. Key concepts embedded within the updated competencies which may be of particular importance for integrated care settings focus on data-informed decision making (e.g., using assessment tools to inform care planning, using technology to facilitate care), communication and information sharing among interdisciplinary home care team members, and establishing and nurturing relationships with clients and caregivers to support participation in care and self-determination. Qualitative feedback emphasized additional opportunities to enhance comprehension of competencies and noted anticipated implementation challenges to be addressed. The updated competencies were released in November 2024.
Implications: Canada’s home health nursing competencies are currently the most up-to-date competencies in the home health nursing sector worldwide. Engagement of a diverse panel of home health nurses in the competency revision process is critical to ensure competencies provide a realistic and meaningful foundation for workforce training and development of initiatives to support provision of high-quality integrated care. This work illustrates strategies to engage a wide range of perspectives during competency development and revision which could be applied in international contexts. Future work will focus on how to support implementation of competencies within home and community care organizations.