Definitions
Core Competencies: A competency model is a framework for defining the skills and knowledge requirements needed to demonstrate proficiency. Core competencies are a constellation of skills, both hard and soft, that together define areas of measurable knowledge and skill. Competency models are widely used in the business and academic sectors to assess knowledge bases and skill sets that ensure standards for consistent, successful job and personal performance.
Curriculum: This refers to the lessons and academic content taught in a school or in a specific course or program, a planned sequence of instruction. It outlines the skills, performance, attitudes, and values pupils are expected to learn; a defined and prescribed course of study.
Study Guide: A study guide is designed to provide a framework for approaching the evaluation of the material that will be covered either in its entirety or as part of the overall course. We are using this term because we intend for trainers to integrate this content into their own syllabi. Inclusion of these core competencies is not meant to limit or impede the offering of any other information or instruction by trainers who are responsible for their own course content.
The NEDA Proficiency Assessment for End-of-Life Doulas evaluates understanding of the contents of each core competency. Choosing to take the assessment is entirely voluntary. Questions are in the form of multiple choice and true or false. Candidates who receive a test score over 85 will be awarded a Proficiency Badge for end-of-life doulas that may be used on websites, brochures, email signatures, and any other written material.
1. Communications and Interpersonal Skills
A. Advocating effectively for the patient, the family, and the EOLD doula profession
1. Advocating for patient priorities, healthcare treatment decisions, and spiritual goals
B. Communicating with the individual’s and family’s wider circles
1. Paper calendars, folders, timelines, medication schedules
2. Care-share interactive websites with information and updates, calendars, message and well-wisher boards, event organization tools, photo galleries
C. Communicating effectively
1. Active listening
2. Critical thinking
3. Creative problem solving
D. Facilitating family issues
1. Techniques for dealing with family dissonance
2. Identifying patterns in family dynamics
3. Knowing when to refer to specialists
4. Accurately communicating what is meant by “getting one’s affairs in order”
5. Assisting the patient and family members in saying goodbye
E. Planning paperwork
1. State-specific advance directive forms
2. Designated power of attorney for healthcare
3. POLST paradigm forms
F. Collaborating with other care providers
1. Building strong channels of communication with outside agencies
2. Encouraging participation and cooperation with the interdisciplinary team
3. Responding constructively and effectively to other people’s ideas and input
4. Creating a community resource list
a. Medical, hospice, hospital, care facility personnel
b. Alternative health practitioners
c. Town, city, county, and state government officials
d. Funeral professionals, home funeral guides, clergy, and others
e. Other community services, such as pet walking, rides, legal support, meals, bereavement support groups, counseling services, etc.
2. Professionalism
A. Protecting yourself in practice
1. Liability protection
2. Written agreements and contracts
3. Fees and payment schedules, invoicing
4. What services doulas can and cannot legally charge for
B. Familiarity with the Institute of Medicine’s Dying in America report
C. Knowing the Patient Bill of Rights
D. Knowing HIPAA requirements for maintaining confidentiality and privacy
F. Knowing the pertinent Hospice Medicare Conditions of Participation § 418
1. Definitions and terminology
2. Reporting procedures and requirements
3. Philosophy and goals
4. Services
5. How to handle an emergency
6. How doulas fit into the current hospice model
G. Knowing local hospital, hospice, and care facility expectations, limitations, policies, and protocols for incorporating doula care
H. Knowing the legal requirements for unattended deaths
I. Committing to ongoing professional education, development, and improvement
J. Recognizing and managing self-care
1. The signs of caregiver burnout
2. Regulating emotions and behaviors
3. Technical Knowledge
A. Knowing about trends and specialties in end-of-life care
1. The Good Death
2. Death Positive movement
3. Palliative care
4. Biopsychosocial cultural spiritual model of care (whole person, whole family)
B. Intuiting what dying individuals want
1. Closure, a pain- and fear-free experience, and affairs in order
2. Self-determinationC. Intuiting what families want
1. Family dynamics, coping mechanisms, and psychological issues surrounding terminal illness, death and bereavement
D. Being familiar with medical protocols
1. Universal precautions
2. What the natural death process looks like
a. Signs and symptoms of approaching death, active dying
3. Voluntary Stopping of Eating and Drinking (VSED)
4. Medically-assisted death
a. Where it is legal
b. What the doula’s role is and isn’t
E. Knowing how care differs in various settings
1. Independent, assisted living, skilled nursing, and hospice facility
F. Preparing and/or managing care plans for family/caregivers
1. Protocol for initial care plan meeting
2. Goals and patient priorities
3. Expectations for actions and timetables
4. Decision-making processes
5. Stumbling blocks and developing contingency plans
6. Structure, schedule, gatekeeper role
7. Goals of care plans
a. Comfort, dignity, choice, meaning, connection, and “dying well”
G. Understanding doula practice
1. The difference between support and doing
2. Cultural humility, what it is, why it is needed, how it looks
3. The needs of special populations
H. Providing doula services
1. Vigils
2. Sacred space
3. Music thanatology
4. Referrals to physical modalities, such as massage, reiki, and acupuncture
5. Life review, meaning of life, legacy work
6. Spirituality
a. What is it, how to address the needs of the dying individual, family, and community
b. What to do when there is spiritual discord
7. Guided imagery or visualization
8. Living funeral/wakes
9. Respite care
I. Offering bereavement follow-up
1. What to look for
2. Identifying when grief counseling is needed and how to make a referral
J. Recognizing and reporting domestic violence/child/elder abuse
1. What to look for
2. Identifying when professional help is needed and how to make a referral
K. Knowing what post-death care entails
1. Who may perform care and under what conditions
4. Values and Ethics
A. Setting professional boundaries
1. Scope of practice and limitations of the doula role
2. Professional behavior consistent with established ethical practice
3. NEDA Scope of Practice
4. NEDA Code of Ethics
B. Maintaining personal boundaries
1. Self-awareness and insight into personal attributes and limitations; appropriate behavior for the role
C. Developing core ethical qualities of doulas
1. Integrity, honesty, fairness, transparency, accountability
D. Understanding the doula model of care
1. Non-medical, non-judgmental, whole person/family care
E. Respecting legal parameters
1. Awareness of and adherence to local, state and federal laws as they pertain to healthcare