Over the picket fence

Categories: Care, Education, and Featured.

An article about the balance between “professional scope of practice” and obtaining and using knowledge from other professions in the field of palliative care.

Why did I write about this?

The motivation for writing this article comes from feedback from my students. I am an E Learning coördinator/Tutor, kennis centrum Nederland. I deliver the Dutch language ICPCN courses, consisting of three courses in children’s palliative, based on a multi-disciplinary approach.

Maraliza de Haan

The feedback from students having to complete an assignment out of their discipline often brings the cry “this does not relate to me!”

One of the students,  Thomas van Heerde,  a spiritual caregiver in Radboud hospital, the Netherlands and part of a multi disciplinary “children’s comfort team” said:

“When I had to do an assignment out of my scope of practice my reaction was:
 “How should I know this? I am not a doctor or nurse!”

This reaction was interesting to me, and led me to write this article.

The experience of open and constructive consultation with colleagues – the case of Thomas van Heerde


Through the E Learning process we inspire students to interview colleagues and also use theory in their study material to complete their assignments. Thomas says that it was through his consultation with all disciplines involved with seriously ill children and their relatives that he learned more about the processes and scope of practice in other disciplines, for example, the dietitian, paediatrician, social worker.

Thomas explained “My initial irritability (how could I know the answer to this assignment as this is not my field) turned into an openness and constructive consultation with my colleagues in the hospital where I work. I appreciate this is ripple effect I appreciate and do not want to miss out on its benefits.”

Thomas_van Heerde

In practice

In practice, we often see examples around the grey area regarding “scope of practice” in obtaining knowledge and “soft skills” from other disciplines. This sometimes results in conflict between colleagues because they feel threatened or irritated by a colleague who is seen as interfering in their “scope of practice”.  It is therefore important to define the terms “scope of practice” and “soft skills”, the tasks and professional approach around this.


Scope of practice

This describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional license. The scope of practice is limited to that which the law allows for specific education and experience, and specific demonstrated competency. Each jurisdiction has laws, licensing bodies, and regulations that describe requirements for education and training, and define the scope of practice. (Wikipedia, 2020)


Soft skills

Are interpersonal skills that characterize a person’s relationship with other people.

(www.invesopedia, 2021). This could also involve an approach based on knowledge and understanding of practices in other disciplines.


For example:

During a clinical procedure, a patient asks: “Doctor am I going to die and how will it be?”

With the doctor using their “soft skills” of knowing how to react,  it would be a moment of quality palliative care.


Knowledge enhances practice

A good understanding and knowledge about practices in other disciplines could have a positive effect on the quality of the clinician’s own practice and approach.


For example:

A spiritual carer’s understanding of a sudden depression and confusion in a patient who has just had a change in medication.  Another example is that all health professionals of the multi-disciplinary team have knowledge about “breaking bad news” as this is a process and not a one-off conversation between one health professional and a patient.



“Looking over the fence”, enhancing your knowledge about other disciplines, gives a better understanding and could contribute to enhancing quality holistic care in palliative care, without stepping into the scope of practice.


“A care we do together” (Thomas van Heerde, April 2021)

Thomas van Heerde

Spiritual caregiver, Radboud hospital, Netherlands


Maraliza de Haan

Coördinator/ Tutor E Learning, Kenniscentrum NL





Picket fence image by bornelectric on Pixabay

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