Competencies: A competency framework for nurses working in Parkinson s disease management

Transcription

1 Competencies: A competency framework for nurses working in Parkinson s disease management

2 Third Edition Acknowedgements Support for funding this document Parkinson s UK Parkinson s Disease Nurse Speciaist Association (PDNSA) PDNSA Committee (3rd edition 2016) Jane Price, PDNSA Chair, PDNS Bronys Hospita, Powys Hannah Martin, PDNS University Hospitas Coventry & Warwickshire NHS Trust Louise Ebenezer, PDNS Princess of Waes Hospita, Bridgend Patricia Cotton, Saford Roya NHS Foundation Trust Juie Shuri, PDNS, The Roya Woverhampton NHS Trust. Caroine Evans, PDNS Hereford Anne Martin, PDNS, King s Coege Hospita London Me Smith, PDNS, Northamptonshire Heathcare NHS Foundation Trust RCN reviewers (3rd edition 2016) Vicky Queen, RCN Neuroscience Forum Committee, Acute PDNS Torbay & South Devon NHS Foundation Trust Tracey Smith, PDNS, East & North Herts NHS Trust PDNSA Committee (2nd Edition) Annette Hand, Nurse Consutant Parkinson s Disease, North Tyneside Genera Hospita Aison Forbes, PDNS, London Ruth Rende, Neuroogy Nurse Speciaist, Norwich and Norfok Linda Caie, PDNS, Aberdeen Geradine Brand, PDNS, PD Surg, London The Parkinson s UK Nurse Deveopment Group Lynne Osbourne, Parkinson s Nurse Consutant, Cornwa Steve Ford, Chief Executive, Parkinson s UK Lesey Carter, Nurse Deveopment Manager, Parkinson s UK Caroine Nobe, PDNS, Peterborough Dr Car Carke, Neuroogist and Reader in Neuroogy, Birmingham Dr Doug MacMahon, Consutant Physician, Cornwa We woud aso ike to thank the Parkinson s Disease Nurse Speciaists, too numerous to mention, who attended the stakehoder days, in particuar: Annette Hand, Nurse Consutant Parkinson s Disease, North Tyneside Genera Hospita, for a her support in coordination and faciitation Phiip Scuion, Coventry University, former Chair RCN Neurosciences Forum, for driving the competencies forward within the RCN Sue Thomas, RCN Nursing Poicy and Practice Adviser and Project Manager Nikki Hae, Senior Feow Competence Deveopment, RCN/Skis for Heath for mapping the competencies to the Knowedge and Skis Framework RCN Neurosciences Forum Executive Committee members (1st edition) Richard Warne, MS Nurse Consutant, Goucestershire Aison Dick, MND, Nurse Speciaist, Befast Shuna Coevie, MND, Nurse Speciaist, Dundee Nikki Embrey, MS Lecturer Practitioner, Birmingham Cath Waterhouse, Lecturer Practitioner, Sheffied Mary Davies, Cinica Nurse Manager, Swansea The Surgica Movement Disorders Nurse Steering Group 2016 Parkinson s UK. A rights reserved. No part of this pubication may be reproduced, stored in a retrieva system, or transmitted in any form or by any means eectronic, mechanica, photocopying, recording or otherwise, without prior permission of the Pubishers. This pubication may not be ent, resod, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is pubished, without the prior consent of the Pubishers.

3 Competencies: A competency framework for nurses working in Parkinson s disease management Contents Acknowedgements Executive summary 4 Gossary 5 Introduction 6 Agenda for Change 7 1. What is a competency framework? 8 The competency eves 9 Structure of the framework How to use the competency framework 12 Producing evidence 12 Assessing competency 13 Evauating the framework Framework deveopment 14 Vaues carification exercise 14 Consutation invoving peope with Parkinson s disease and their carers 14 Competency framework The competency framework for nurses working in Parkinson s disease management 16 1 Case management 16 2 Accountabiity 18 3 Providing support and advice to peope with Parkinson s disease and carers 20 4 Assessment, panning, impementation and evauation 21 5 Symptoms management 23 6 Medicines management 25 7 Referra to the mutidiscipinary team 27 8 Education 28 9 Research and audit Management through the four stages 31 Professiona and persona deveopment Assessing and managing compications 34 Psychoogica probems 34 Motor and non-motor fuctuation 35 Promoting independence 36 Concurrent iness Mobiity and fas Functiona surgica management 41 References 43 Usefu resources 44 3

4 Executive Summary Parkinson s disease is a compex progressive neuroogica condition which, according to Parkinson s UK currenty affects over 127,000 peope in the UK. 1 The motor and non-motor symptoms can be addressed through care panning, anticipatory care and timey intervention. In order to achieve this, coaboration between patients and heath care professionas across the muti-discipinary team is essentia. The Parkinson s disease nurse speciaist (PDNS) utiises knowedge, skis and best practice to meet the needs of peope iving with this ong term condition. 22 This revised competency framework describes professiona criteria in the form of competencies, which incude the knowedge, education and skis required by experienced nurses who wi optimise symptom contro to maximise quaity of ife when caring for a person with Parkinson s (PwP) and atypica Parkinsonian syndromes. These skis are transferabe across heath care settings, and wi provide signposts for best recommended practice. This competency framework addresses a number of poitica and professiona issues, incuding: Agenda for Change 2 The need for eadership in nursing. The need for the deveopment of standards. Fitness for practice. Work-based and ifeong earning. Cinica supervision for nurses. NHS Knowedge and Skis Framework 3 This document is in ine with, and mapped to, the NHS Knowedge and Skis Framework (KSF). NMC revaidation 4 These competencies wi aso be usefu with supporting nurses through their Nursing Midwifery Counci (NMC) revaidation process. The competencies were originay deveoped by Parkinson s disease nurse speciaists (PDNS) across the UK. In deveoping the subsequent revised editions of these guideines, various documents reating to Parkinson s disease (PD) and the roe of the PDNS have been considered in order for the competencies to remain current, up-to-date, and reevant within the current modern NHS service. Key usefu documents can be found in the Usefu Resources section on page 44. 4

5 Gossary ABN ABPI ACP AFC CBD DaT DAWS DBS DDS DoH DLB ESS GD GP GDS HADS HWB ICB IPD IK IT HCA HCP KSF NSF MDT MOCA MSA Association of British Neuroogists Association of the British Pharmaceutica Industry Anticipatory care pan Agenda for Change Corticobasa degeneration Dopamine transporter scan Dopamine agonist withdrawa syndrome Deep brain stimuation Dopamine dysreguation syndrome Department of Heath Dementia with ewy bodies Epworth seepiness scae Genera dimensions KSF Genera practitioner Geriatric depression scae Hospita anxiety and depression scae Heath and webeing dimensions KSF Impuse contro behaviour Idiopathic Parkinson s disease Information and knowedge Dimensions KSF Information technoogy Heath care assistant Heath care professiona Knowedge and Skis Framework Nationa Service Framework for ong-term conditions Muti-discipinary team Montrea cognitive assessment Mutipe system atrophy NBM Ni by mouth NHS Nationa Heath Service NICE Nationa Institute for Cinica Exceence NMSQ Non motor symptom questionnaire NMSS Non motor symptom severity too NMC Nursing and Midwifery Counci OSCE Observed structured cinica examination QOL Quaity of ife PDD Parkinson s disease dementia PEN UK Parkinson s Exceence Network PDNS Parkinson s disease nurse speciaist PDNSA Parkinson s Disease Nurse Speciaist Association PDQ39 Parkinson s disease quaity of ife too PREP Post-registration education and practice PSP Progressive supranucear pasy PwP Person with Parkinson s RCN Roya Coege of Nursing SIGN Scottish Intercoegiate Guideines Network UPDRS Unified Parkinson s disease rating scae 5

6 Introduction Competence can be defined as: The state of having the knowedge, judgement, skis, energy, experience and motivation required to respond adequatey to the demands of one s professiona responsibiities. 7 This integrated career and competency framework for Parkinson s disease management is of great importance, as it incorporates a number of poitica and professiona issues and initiatives, incuding: the management of Parkinson s disease in primary and secondary care 5 the diagnosis and pharmacoogica management of Parkinson s disease 6 Parkinson s Disease Nurse Speciaist Association (PDNSA) UK Parkinson s Exceence Network the NMC Code 8 Agenda for Change 9 the NHS Knowedge and Skis Framework and the Deveopment Review process the need for eadership in speciaist nursing the need for the deveopment of standards the NHS Pan 10 and its equivaent in Scotand, Waes and Northern Ireand increased focus on work-based and ifeong earning pus supervision. What roes are required? In ine with the principes of the NHS pan, the government aims to modernise heath services in this country. Among other things, the pan proposed that nurses wi have an expanding roe as nurse speciaists and nurse consutants. Deveoping new roes for nurses generates opportunities to expand the range of services avaiabe for cients with conditions ike Parkinson s, in addition to exciting career deveopment prospects for nurses. The NMC is providing competencies for advanced nursing practice. Education and training agendas need to refect these changes if nurses are to advance their cinica roes. Nurses new to the fied of Parkinson s nursing require a cear framework to enabe them to deveop their skis and knowedge continuay, according to their position in the nursing career trajectory. Experienced PDNSs require a framework to hep them advance and progress. What does this framework hope to achieve? This document outines a nationa framework of competencies that PDNS and nurses with an interest in Parkinson s can use to practise as safe, effective and accountabe practitioners in Parkinson s care and management. Work on this revised version of the origina competency document was ed by the PDNSA and faciitated by the RCN Neurosciences Forum; this third edition has been funded by Parkinson s UK and the PDNSA. 6

7 Agenda for Change This competency framework was deveoped primariy to support nurses deivering services in the community, and not specificay to support the NHS Knowedge and Skis Framework (NHS KSF), but. it can be used to compement the NHS KSF dimensions by providing specific competencies reated to Parkinson s disease management and may support career and pay progression. It shoud not, however, be used as a means to determine pay banding under the Agenda for Change pay modernisation process. The NHS KSF NHS KSF components The six core and specific dimensions are: communication persona and peope safety heath safety and security service improvement quaity equaity and diversity. There are other dimensions which appy to some jobs but not a; these have been grouped into themes: heath and webeing estates and faciities information and knowedge genera. Overview of the NHS KSF The NHS KSF defines and describes the eve of knowedge and ski NHS staff require to deiver quaity services. It provides a singe consistent comprehensive and expicit framework on which to base review and deveopment for a staff. 3 The NHS KSF is made up of 30 dimensions. These dimensions identify broad functions that are required by the NHS to enabe it to provide a good quaity service to the pubic. As the NHS KSF is a broad generic framework that focuses on the appication of knowedge and skis, it does not describe the exact knowedge and skis individuas need to deveop for PD nursing specificay. The competencies detaied throughout the foowing pages hep to do this, as wi specific training courses in Parkinson s disease management. 7

8 1 What is a competency framework? When is a nurse competent? A nurse is competent when (s)he possesses the skis and abiities required for awfu, safe and effective professiona practice without direct supervision. Competencies can be thought of as underying characteristics of individuas that resut in effective performance, and are described as a combination of knowedge, skis, motives and persona traits. Competency in this sense is generay seen in the way someone behaves. A competency framework is a coection of competencies that are thought to be centra to effective performance. This framework describes the competencies that PDNSs need to achieve and maintain in order for their care to be awfu, safe and effective. The framework can be used to: faciitate continuing professiona deveopment on an individua eve assist with training and deveopment activities hep managers (or cinica mentors, incuding doctors) and individua nurses to review their strengths strengthen, and identify gaps in, their competency highight specific training and deveopment needs inform the commissioning, deveopment and deivery of education and training for PDNSs aid performance appraisa reviews support NMC revaidation 4 support recruitment and retention within the speciaty assist universities to recognise the earning requirements of PDNSs and deiver programmes to support them. Competence-based earning Considerabe work has aready been invested in the deveopment of competency-based frameworks by the RCN, and a vaidated competency framework has been deveoped. It coud be argued that one approach be adopted as a standard. However, each earning programme offers a different perspective according to the work environment and infrastructure for support, mentoring and assessment. In addition, some NHS trusts may aready have estabished competency earning programmes. Therefore, specific competencies for Parkinson s can be adapted from the nationa framework and incorporated with existing oca earning packages. 26 Defining the eves of nursing practice In 1999, a new career structure was proposed to repace cinica grades for nurses, midwives and heath visitors. This structure incorporated the new nurse, midwife and heath visitor consutant posts that are significanty extending the career opportunities for nurses who wish to cimb the career adder, but remain in cinica practice. 10 In September 2006, the Department of Heath reeased its pubication Modernising Nursing Careers: Setting the Direction, which incuded panned action for the four heath departments across the UK to work with stakehoders to map nursing roes and competencies to the Nationa NHS Careers Framework. 11 The career framework consists of nine eves and, for the purposes of this document, potentia descriptor eves wi be incuded in brackets against those eves described in the career trajectory. The career framework for heath 12 can be viewed at 8

9 The competency eves The competency eves in this document were originay based on the career trajectory and aigned to Benner s stages of cinica competence that extend from novice to expert. 13 Heath care assistants (HCAs) are at the first eve of the career trajectory which equates to eves 1, 2, 3 and 4 of the Career Framework for Heath. 12 The competency statements in this document do not address the needs, of this group of workers. Registered competent nurse (Leve 5 of the Career Framework for Heath) This eve defines the entry point for registered nurses to the Parkinson s disease speciaty. At this eve, the registered practitioner in the Parkinson s service wi: deveop expertise assess and manage patients throughout the four stages of Parkinson s 14 demonstrate working knowedge of the key speciaist psychosocia and technica treatments that are appropriate to a PwP work on a reguar, but not necessariy fu-time, basis with a PwP deveop interpersona skis initiate discussions on the impact of IDP on persona reationships assess QOL and ADLs earn when and how to refer cients to the mutidiscipinary team (MDT) earn how to document patient care appropriatey. Experienced speciaist nurse (Leve 6 of the Career Framework for Heath) At this eve the registered practitioner in the Parkinson s service wi: have deveoped expertise in using detaied theoretica and practica knowedge in Parkinson s management have increased critica understanding of theories and principes demonstrate mastery of methods and toos in compex care demonstrate innovation have the abiity to devise and sustain arguments to sove probems. Expert speciaist nurse (Leve 7 of the Career Framework for Heath) Often regarded as a speciaist or expert practitioner, PDNS practising at this eve of cinica practice work according to oca protocos. They co-ordinate the comprehensive care of patients, who coud equay be cared for by doctors. The nurses can work autonomousy without asking the advice of a doctor. Any nurse working at this eve is required to work within the boundaries of their own knowedge and competence, and refer to or seek advice/opinions from medica coeagues for cases beyond their cinica expertise. Seected treatments wi expand this nursing roe through independent non-medica prescribing. The expected workoad of senior registered practitioners differs between settings, depending on oca need, resources and infrastructure. In day care settings some nurses are responsibe for the tota provision of care, others ony see patients who have previousy been seen by medica coeagues, whie some nurses see cients who coud equay be cared for by doctors. Despite the different types or eves of patient care that PDNSs provide, there are core competencies that are centra to a eves of senior registered PDNS nursing practice. Consutant nurse (Leve 8 of the Career Framework for Heath) Previousy defined as a higher eve of practice, this eve generay refects the roe of the nurse consutant. Nurse consutant posts are deveoped to satisfy the individua needs of the service in which they are ocated. However, a posts need to conform to a common core of expectations outined by the NHS Executive, which are: expert practice professiona eadership and consutancy education, training and deveopment practice and service deveopment, research and evauation. 9

10 Roe eve descriptors Leve Skis and knowedge Supervision Reguation, professiona and vocationa competence 5 Use broad theoretica and speciaised knowedge within a fied and show awareness of own imitations. Deveop strategic and creative responses in researching soutions to we defined concrete and abstract probems. Appy theory to practice to sove probems. 6 Has good practica theoretica knowedge. Some knowedge is at the forefront of the fied and wi invove a critica understanding of theories and principes. Improve understanding of methods and toos in a compex and speciaised fied and demonstrate innovation in terms of methods used. Devise and sustain arguments to sove probems. Manage projects independenty that require probem soving where there are many factors, some of which interact and ead to unpredictabe change. Show creativity in deveoping projects. Manage peope and review performance of sef and others. Train others and deveop team performance. Demonstrate administrative design, resource and team management responsibiities in work and study contexts that are unpredictabe and require that compex probems are soved where there are many interacting factors. Show creativity in deveoping projects and show initiative in management processes that incude the training of others to deveop team performance. Cinica staff wi be reguated heathcare professionas. Evauate own earning and identify earning needs required to undertake further earning. Formuate pan of action to sove a probem. Demonstrate experience of operationa interaction within a fied. Make judgements based on knowedge of reevant socia and ethica issues. Cinica staff wi be reguated heath care professionas. Consistenty evauate own earning and identify earning needs. Gather and interpret reevant data in a fied to sove probems. Demonstrate experience of operationa interaction within a compex environment. Make judgements based on socia and ethica issues that arise in work or study. 7 Use highy speciaised theoretica and practica knowedge, and understanding. This knowedge forms the basis for originaity in deveoping and/or appying ideas. Demonstrate critica awareness of knowedge issues in the fied and at the interface between different fieds. Create a research-base diagnosis to probems by integrating knowedge from new or MDT fieds and make judgements with incompete or imited information. Deveop new skis. 8 Use speciaised knowedge to criticay anayse, evauate and synthesise new and compex ideas that are at the most advanced frontier of a fied. Extend or redefine existing knowedge and/or professiona practice within a fied or at the interface between fieds. Research, conceive, design, impement and adapt projects that ead to new knowedge and new procedura soutions. Demonstrate eadership and innovation in work and study contexts that are unfamiiar, compex and unpredictabe and that require soving probems invoving many interacting factors. Review strategic performance of teams. Demonstrate substantia eadership, innovation and autonomy in work and study contexts that are nove and require the soving of probems that invove many interacting factors. Cinica staff wi be reguated heath care professionas. Demonstrate autonomy in the direction of earning and a high eve understanding of earning processes. Sove probems by integrating compex knowedge sources that are sometimes incompete and in new and unfamiiar contexts. Demonstrate experience of operationa interaction in a compex environment. Respond to socia, scientific and ethica issues that are encountered in work or study. Cinica staff wi be reguated heath care professionas. Demonstrate capacity for sustained commitment to deveopment of new ideas or processes and a high-eve understanding of earning processes. Critica anaysis, evauation and synthesis of new and compex ideas and strategic decision making based on these processes. Demonstrate experience of operationa interaction with strategic decision making capacity within a compex environment. Promote socia and ethica advancement. Reproduced from Skis for Heath (2006) Career Methodoogy Testing Report

11 Structure of the framework Three eves of cinica practice The framework consists of three eves of cinica practice, and is centred on the patient experience in the PD MDT setting, as we as genera professiona nursing practice. Competent nurse (Leve 5) Experienced speciaist nurse (Leve 6) Expert speciaist nurse (Leve 7/8) Each eve of practice has a number of areas of competency that refect: the core aspects of professiona nursing practice those aspects that are specific to Parkinson s, with a particuar focus on the patient experience. The areas of competency contain the specific competencies: each contains an overarching statement that gives an overa favour of what the competency is about. A number of statements, known as behavioura indicators which: represent the specific behaviours you woud expect to see if the competency is appied effectivey the behavioura indicators that refect the knowedge, skis and attitudes required for effective, accountabe and acceptabe cient care. 11

12 2 How to use competency framework This document is for nurses working with PwP and their carers. It shoud be used in combination with, and as a compement to, the UK-wide RCN Core Competency Framework, together with the Skis for Heath Neuroogica Competency Framework 15 (avaiabe at A number of competencies within the Long Term Conditions Case Management Community Matrons Framework woud aso be appicabe to nurses deveoping competency in this fied and woud be a usefu reference point. See Aso, for those nurses working within the NHS, it shoud be used in conjunction with the KSF. This document focuses specificay on technica treatments reated to Parkinson s nursing. The framework shoud be used for: deveoping and empowering nurses working in the Parkinson s care fied the management of performance within professiona deveopment appraisa schemes. In the NHS, this has to be undertaken in conjunction with the KSF for the individua s roe. Nurses using the framework wi need to produce evidence for each competency in order to demonstrate that they have achieved the competence at the identified/desired eve. Various approaches shoud be combined, rather than seecting one approach. This evidence wi aso hep with NMC revaidation in meeting requirements for this process. Producing evidence Beow are exampes of what coud be used as evidence. These exampes are not exhaustive, and aternative assessments may be appropriate in different settings: observation and critica anaysis of everyday practice audit and notes review case presentations OSCEs diary refections of diary or deveopment needs and an action pan testimony of the individua s contribution to nursing practice, such as the co-ordination of care management for an individua or a group of patients active contribution to poicy groups, deveoping for reviewing guideines, standards and audit evidence of change or project management certificate of attendance and an evauation of the outcomes of study days or courses demonstration of evidence-informed practice, with supportive iterature, protocos, etc panning, deivering and evauating teaching sessions 360 feedback process persona and professiona deveopment portfoio active invovement in cinica supervision, mentorship and mutidiscipinary meetings demonstration of abiity to iaise with the mutidiscipinary team and externa agencies a reevant contribution to a verba discussion about patient care that is appropriate for the individua nurse s eve contribution to oca or nationa documents or journas about service deivery, education, etc eading or contributing to a journa cub or other in-house teaching and earning sessions written documentation about patient care that is appropriate for the individua nurse s eve. 12

13 Assessing competency Athough the strength of the competency framework ends itsef to assessment of nursing practice at oca eve in MDT coeagues, assessment may aso take pace through university courses and forma examinations. The competency framework provides guidance for assessment, but aternative assessments may be appropriate in different settings. Those performing the assessments shoud have adequate expertise and training in the assessment and mentoring process, in addition to appropriate knowedge in PD care. As an exampe, the medica cinica ead in the NHS trust shoud have cinica responsibiity for the service and expect to be invoved in the assessment process. Evauating the framework Evauation methods There are two measures that can be used to evauate the effectiveness of the competency framework: Process measures focus groups to determine: if and how the framework is being used ease of use and probems gaps in information. Outcome measures pre-competency Baseine assessment of a representative sampe to estabish existing eve of competence according to the framework. This woud aso indicate gaps in competence and regiona practice patterns in order to inform the commissioning, deveopment and deivery of education and training for Parkinson s nurses. Repeat survey after period of time to estabish if the eve of competence has changed among sampe participants. 13

14 3 Framework deveopment Vaues carification exercise The competency framework has been deveoped foowing extensive consutation. Initiay, PDNSs and nurses with a specia interest in PD competed a questionnaire to indentify their vaues and beiefs in Parkinson s nursing. A posta questionnaire was circuated to a database of known PDNSs, obtained from the PDNSA. Of the 245 questionnaires circuated, 195 were returned competed. There was a good geographica spread with responses from each NHS region in Engand, and from Waes, Scotand, Northern Ireand and the Channe Isands. Responses were coated and themes generated from the contributions received. PDNSs responding to the questionnaire said that the purpose of Parkinson s nursing is to: maintain and improve quaity of ife for peope with Parkinson s provide support and education to peope with PD and their famiies in any ocation support and provide a seamess service throughout the disease trajectory educate other heath care professionas. PDNS beieved that this coud be achieved through: a mutidiscipinary, patient-centred approach to care that has a strong focus on independence highy motivated nurses easy access to care. The questionnaire highighted the core work of the PDNS as: providing support and advice to patients and carers assessment symptoms management medicines management education and awareness of professionas referra to mutidiscipinary team anticipatory care. research and audit. Consutation invoving PwP and their carers As part of deveoping the competency framework, a consutation exercise was undertaken with PwPs and their carers to find out what they vaued from their interactions with a PDNS. A focus group exercise and posta questionnaires were used to obtain views from 240 patients and carers who were at varying stages of the disease process. The vaue of the PDNS from this exercise was defined as: avaiabiity of the nurse and their abiity to respond quicky expert knowedge abiity to signpost and navigate the heath care system information-giving. The red fag issues PwPs raised were: time it takes to see nurse soon after diagnosis no singe source of information for PwP currenty appropriate services and benefits are spread over many disparate organisations patients drop out of view at various stages of treatment, and have to be re-registered or re-referred review process for patients is inconsistent, both in time and quaity support in the paiative care stages is uncear. PDNS core competencies were subsequenty drafted and sent out for consutation. The framework deveoped was divided into sections. 14

15 Competency framework Care management Accountabiity Care of peope with Parkinson s disease and their carers Providing support and advice Assessing and managing compications Assessment Managing through the four stages Symptoms management Reaearch and audit Medicines management Education Referre to mutidiscipinary team 15

16 4 The competency framework for nurses working in Parkinson s management Speciaist competency 1: case management (Leve 5) Causes of Parkinson s disease Deveops knowedge of the potentia causes of Parkinson s. Cassification Shows awareness of the four-stage management concept of Parkinson s, and how each stage differs: 1. diagnosis 2. maintenance 3. compex 4. paiative. 14 Pathoogy Deveops an understanding of the aetioogy of Parkinson s. Recognises how fraity and other co morbidities impact on PD. Management Deveops knowedge of: symptoms of Parkinson s atypica Parkisonian syndromes (incuding MSA, PSP, CBD, PDD, DLB) management options functiona surgery non ora therapies possibe adverse effects of medications incuding impuse contro behaviour (ICB). Experienced speciaist nurse (Leve 6) Causes of Parkinson s disease Links the pathoogy of Parkinson s to management options. Expains and discusses the pathoogy of Parkinson s to PwP, their carers and MDT. Cassification Understands the pathoogica differences underying Parkinson s and Parkinsonism. Demonstrates knowedge of diagnostic criteria and understands the use of drugs in management of Parkinson s. Demonstrates knowedge of the four-stage management concept and iaises with the muti discipinary team (MDT). Pathoogy Expains how Parkinson s occurs. Describes and discusses the aetioogy of Parkinson s and interprets this to the PwP and their famiy. Management Describes/discusses/expains Parkinson s to other professionas, PwP and carers: IPD and atypica Parkinsonian syndromes Expert speciaist nurse (Leve 7/8) Causes of Parkinson s disease Teach staff and MDT professionas about new theories and research deveopments. Expand eve of knowedge and critica anaysis. Cassification Discusses the appication of management in each distinct stage of Parkinson s. Pathoogy Outines the current theories of Parkinson s to experienced staff. Expains the natura history data in Parkinson s. Expains pathoogy in reation to functiona surgery. Management Educates experienced heath professionas on the disease presentations and symptoms. Works with other professionas to design and impement care pathways in anticipation of potentia probems. Designs, deveops and impements care pathways in reation to functiona surgery, and or non ora therapies. Educates experienced heath professionas about functiona surgery interventions. 16

17 Speciaist competency 1: case management continued (Leve 5) Outcome measurement Shows awareness of assessment scaes used in the management of Parkinson s. Shows awareness of the need to undertake quaitative outcome assessment for PwP and their carers. Psychoogica and socia impact Deveops awareness of: cognitive impairment neuropsychiatric features psychoogica impact emotiona need reationship and communication issues and their potentia effect on PwP and their carers. Indicative KSF Dimensions and eves: Core 1 eve 3 Core 2 eve 3 Core 5 eve 2 IK2 eve 2 Experienced speciaist nurse (Leve 6) Knowedge of idiopathic PD, genetic PD, and atypica Parkinsonism. Links signs with symptoms and treatment options using evidencebased management protocos. Functiona surgica options and other non-ora therapies. Management and rehabiitation options. Use of drug therapy in the management of Parkinson s incuding screening and monitoring for ICB, DAWS, DDS. Outcome measurement Uses and interprets resuts from a range of scaes, incuding quaity of ife outcomes, and discusses management options. Understands common imitations associated with the cinica use of scaes. Peer reviews existing, or deveops new, quaitative patient outcome measures that can be adapted/ enhanced to measure eements of patient care. Psychoogica and socia impact Uses knowedge of patterns of psychoogica and socia impact in Parkinson s to respond and to manage the needs appropriatey. Shows awareness of potentia psychoogica and socia impact in reation to functiona surgery. and eves: Core 1 eve 3 Core 2 eve 3 Core 4 eve 2 Core 5 eve 3 IK2 eve 3 Expert speciaist nurse (Leve 7/8) Has an understanding of the wider poitica environment and how it impacts on service redesign. Outcome measurement Identifies scaes appropriate for specific cinica measurement. Understands the significance of reiabiity and vaidity data reated to outcome measures. Identifies gaps in the service, and initiates strategies to address them from quaitative outcome measures. Psychoogica and socia impact Demonstrates expertise in the recognition of signs psychoogica issues, addresses and socia impact and its effect on assessment and management. Demonstrates expertise in assessing and recognising psychoogica and socia impact pre- and post-functiona surgery. Manages these, or refers to other members of the MDT as appropriate. Indicative KSF Dimensions and eves: Core 1 eve 4 HWB2 eve 4 Core 2 eve 4 HWB4 eve 4 Core 4 eve 4 HWB5 eve 4 Core 5 eve 4 IK2 eve 4 Core 6 eve 4 G1 eve 3 17

18 Speciaist competency 2: accountabiity (Leve 5) Scope of practice Works within the scope of the most recent NMC Code of professiona conduct. Discusses scope of professiona practice in reation to current roe. Accountabiity for service demands Deveops and manages own caseoad, recognising unacceptabe workoad and identifies when it is appropriate to seek support. Documentation Maintains accurate records and appies current knowedge of data protection and confidentiaity issues. Evidence-based practice Accesses and works to best practice guideines using evidence-based practice where avaiabe. Seeks support as required. Informed consent Adheres to the principes of informed consent in the nationa consent guidance. Experienced speciaist nurse (Leve 6) Scope of practice Works fexiby within the NMC scope of professiona practice, and identifies and deveops new ways of working. Accountabiity for service demands Demonstrates accountabiity in prioritising and managing workoad in response to changing service priorities. Documentation Peer reviews existing, or deveops new, patient documentation that can be adapted/enhanced to record the care of PwP. Evidence-based practice Uses own cinica expertise with the cinica governance framework and evidence-based practice to advise others on the management of peope with PD. Identifies gaps in the evidence base and coaborates with others to address them. Informed consent Assesses patient iteracy eves, and monitors the patient s understanding of informed consent for treatment. Expert speciaist nurse (Leve 7/8) Scope of practice Shows awareness of the codes of practice of other heath care professions, and where the ine is for the duty of care in the MDT. Gains agreement as to where responsibiity ies in the MDT. Accountabiity for service demands Takes a strategic overview of the service, exporing aternatives for managing case oad. Is accountabe for recommending redesigns to the service that invoves other professionas, and justifies additiona member of the team. Documentation Deveops documentation that faciitates and improves communication between primary, secondary and tertiary care, such as joint records hed by the MDT, hand-hed notes or IT soutions. Evidence-based practice Identifies gaps in the evidence base and initiates strategies to address them. Informed consent Advises, supervises and coordinates peer group and senior staff on the ethica issues of informed consent. 18

19 Speciaist competency 2: accountabiity continued (Leve 5) Reationships with industry Shows awareness of pharmaceutica and commercia invovement in PD management. Identifies trust poicy on appropriate reationships with commercia sector. Shows awareness of nationa guideines for ethica standards of working, is aware of the Association of the British Pharmaceutica Industry code of conduct. 16 and eves: Core 1 eve 3 Core 2 eve 3 Core 5 eve 2 HWB a dimensions and eves Experienced speciaist nurse (Leve 6) Reationships with industry Deveops and maintains professiona reationships with commercia organisations for the benefit of PwP. Understands ABPI code of conduct. and eves: Core 1 eve 3 Core 2 eve 3 Core 4 eve 2 Core 5 eve 3 HWB a dimensions and eves IK3 eve 3 G5 eve 3 Expert speciaist nurse (Leve 7/8) Reationships with industry Uses experience and expertise to infuence the pharmaceutica and commercia industry to improve patient care. Understands and can interpret the ABPI code of conduct. and eves: Core 1 eve 4 Core 2 eve 4 Core 4 eve 4 Core 5 eve 3 HWB a dimensions and eves IK3 eve 4 G5 eve 3 G6 eve 4 19

20 Speciaist competency 3: providing support and advice to PwP and carers (Leve 5) Sef-management Deveops a reationship based on trust. Deveops an understanding of the strategies used in sefmanagement. Advocacy Acts as an advocate for the PwP and their famiy at team eve to remove barriers to care and services. Service user deveopment Deveops awareness of issues reated to service deveopment and service user invovement. Teephone/eectronic communications management. Demonstrates effective istening and questions skis appropriate to teephone communication, ensuring the caer fees confident that their needs have been understood. Recognises importance of information governance as per oca protocos. Teephone management/ prioritising time Manages time effectivey by assessing the urgency of cas. and eves: Core 1 eve 3 Core 2 eve 3 Core 4 eve 2 Core 5 eve 2 Core 6 eve 3 Experienced speciaist nurse (Leve 6) Sef-management Encourages the individua and their famiy to foster a sefmanagement approach. Support, impement or run sefmanagement programme. Advocacy Acts as an advocate for PwP and their famiy at a departmenta/ unit/community team eve. Participates in user groups, ooking at service deveopments within resource constraints. Deveops active contact with patient services. Service user deveopment Provides opportunities PwP to pay a part in the deveopment in oca services. Teephone management/ eectronic communication Effectivey assesses and prioritises need, based on teephone communication. Agree reaistic expectation with PwP. Manages crisis and unexpected cas confidenty. Teephone management/ prioritising time Agrees reaistic expectations in the management of teephonedependent patients. and eves: Core 1 eve 3 Core 4 eve 2 Core 5 eve 3 Core 6 eve 3 HWB4 eve 3 Expert speciaist nurse (Leve 7/8) Sef-management Empowers the individua and their famiy to identify and reach reaistic goas of sefmanagement. Advocacy Advocates on behaf of the oca Parkinson s popuation at a strategic/trust commissioning eve to ensure services are deveoped effectivey. Ensures the user s voice is recognised in service impementation and deveopment, within resource constraints. Service user deveopment Creates opportunities at different eves for PwP to pay a part in the deveopment of oca services. Teephone management reationships Deveops strategies to monitor and manage effectivey issues raised during teephone contact. Teephone management/ prioritising time Identifies the reasons for a patient s teephone dependency and deveops strategies to meet them. and eves: Core 1 eve 4 Core 4 eve 4 Core 5 eve 3 Core 6 eve 4 HWB4 eve 4 G5 eve 4 20

21 Speciaist competency 4: assessment, panning, impementation and evauation (Leve 5) Assessing the patient Obtains consent from individuas before initiating assessment. Undertakes an hoistic patient assessment to determine accuratey actua and potentia probems that might require attention. Uses an evidence-based and person-centred assessment approach to identify heath care and education needs. Adjusts assessment and history, taking into account age, gender and cutura background. Assesses patients eve of vunerabiity due to age and disabiity. Assesses appropriate additiona information about a patient and communicates that information. Assesses the abiity and motivation of the patient and carer to sef-manage care shows knowedge of cinica rating scaes. Using assessment data to impement and evauate a pan of action. Agrees a care pan in partnership with patient and, in coaboration with others, impements a care pan for the cient group using an evidence-based and patientcentred approach. Sets and monitors patients goas in coaboration with patient and other members of the team using an evidence-based and patientcentred approach. Experienced speciaist nurse (Leve 6) Assessing the patient Assesses heath and webeing needs when those needs are compex and change across the case oad. Has knowedge of cinica rating scaes. For exampe: UPDRS Swab and Engand PDQ 39 NMSS HADS ESS. Accuratey conducts a heath and risk assessment using (these) recognised assessment toos, and together with a physica examination, interprets and acts on findings. Discusses assessment outcomes with patients/cients and coeagues, enabing them to think through the risks, their effective management and the need for referra to others. Has knowedge of speciaist cinica rating scaes. For exampe: MOCA GDS. Using assessment data to impement and evauate a pan of care Makes decisions in coaboration with patients and other team members about care priorities for a range of patients. Expert speciaist nurse (Leve 7/8) Providing expert assessment, panning, impementation and evauation Decides on assessment priorities in the care setting for a range of patients. Experty interprets a of the information avaiabe. Makes a justifiabe assessment of peope s heath and webeing needs and their prognosis, together with risks to their heath and webeing in the shorter and onger term. Transfers and appies knowedge to new needs and issues, expaining ceary to coeagues his/her own reasoning processes as the assessment proceeds. Works nationay or internationay in partnership to deveop and vaidate cinica rating scaes that improve cinica assessment. Recognise and incorporate any new scaes into service. Undertakes appropriate speciaist assessment in reation to function surgery, and experty interprets resuts. Using assessment data to impement and evauate a pan of care Contributes to the decisionmaking process of options reating to functiona surgery. Makes decisions on service redesign to deiver best practice. Acts as a catayst for change. 21

22 Speciaist competency 4: assessment, panning, impementation and evauation continued (Leve 5) Experienced speciaist nurse (Leve 6) Expert speciaist nurse (Leve 7/8) Evauates a care pan for, and with, the cient group using an evidence-based and patientcentred approach. Liaises between the patient/carers and other members of the MDT, incuding other agencies, to achieve the care pan. Uses assessment data to provide the rationae for cinica decision-making Assimiates the information gathered at assessment to provide the rationae for cinica decisionmaking. Has knowedge of speciaist cinica rating scaes. For exampe: MOCA. Documentation of assessment, panning, impementation and evauation Documents cear and accurate information about the patient arising from the assessment and care panning process, and communicates this to others. and eves: Core 1 eve 3 HWB2 eve 3 Core 2 eve 3 HWB4 eve 2 Core 5 eve 2 HWB5 eve 3 Core 6 eve 3 IK2 eve 2 Speciaist heath and risk assessment, panning, impementation, evauation and cinica decision-making Undertakes speciaist heath and risk assessment and care panning processes consistent with evidence-based practice and own scope of practice. Abe to convey the care pan to patient, MDT (incuding consutant and genera practitioner in writing). Team standards in assessment, panning, impementation and evauation Monitors the assessment and care panning processes provided by the team for a range of patients in cient group. Faciitates others in the deveopment of competence in speciaist assessment and care panning processes. and eves: Core 1 eve 3 HWB4 eve 3 Core 2 eve 3 HWB5 eve 3 Core 5 eve 3 IK2 eve 2 HWB2 eve 3 G5 eve 3 HWB3 eve 2 Impementing organisationa approaches to enabe patients to receive skied assessment, panning, impementation and evauation Deveops referra pathways for patients requiring other treatments. Deveops oca networks for supporting staff. Disseminates information about speciaist assessment and care panning processes. Deveoping a cuture that constanty evoves assessment strategies and care panning processes Identifies situations where the scope of practice needs to be expanded to improve the service and subsequent educationa needs. and eves: Core 1 eve 4 HWB5 eve 4 Core 2 eve 4 G1 eve 3 Core 4 eve 4 G5 eve 3 Core 5 eve 3 G6 eve 4 HWB2 eve 4 G2 eve 3 HWB3 eve 3 IK2 eve 4 22

23 Speciaist competency 5: symptoms management (Leve 5) Deveoping knowedge Recognises and describes signs and symptoms of common conditions in PwP. Has up-to-date information about the treatment and management of common motor and non motor symptoms, potentia side effects of medication. Impements actions and knowedge arising from own refections and cinica supervision. Impements oca action pans in reation to essence of care benchmarking. Understanding patient need Identifies the physioogica, psychoogica, socia, cutura, deveopmenta, sexua and spiritua needs of the person. Identifies the individua s coping and adjustment strategies, their motivation and support mechanisms. Practice Demonstrates abiity to identify and manage probems, or signpost PwP to appropriate source of hep and support. Accountabiity Understands the principes of accountabiity in reation to symptom management. Experienced speciaist nurse (Leve 6) Deveoping expertise Demonstrates abiity to identify cinica probems and undertakes timey intervention and management of symptoms. Demonstrates awareness of the various sources of pharmaceutica information and uses a fu range of strategies to hep reieve/address symptoms. Provides the team with oca expertise on aspects of NICE/ SIGN guideines on PD management. Uses and acts on knowedge of norma and uncharacteristic physioogy in caring for patients. Understands patient need Criticay evauates patient data to seect and impement appropriate symptom management, and reviews a reevant information about the individua s condition and symptoms. Anticipates the effects of symptoms on the peope with PwP and carer/famiy, adjusts care to enhance webeing and responds appropriatey. Anticipates the ikey course of interventions, treatment and therapies, and uses own speciaist knowedge to achieve the best outcome. Identifies the most appropriate activities to assist the individua to manage their symptoms, and encourages the individua to report any significant change in their symptoms. Expert speciaist nurse (Leve 7/8) Demonstrating expertise Demonstrates a the characteristics of expertise, specificay: uses hoistic practice knowedge knows the patient can recognise, prioritise and triage the management of symptoms impements comprehensive knowedge into practice acts as a catayst by creating understanding, enabing new ways of working, and by infuencing coeagues practice questions and reviews practice, and responds innovativey demonstrates sef-awareness by chaenging own practice and seeking improvement. and eves: Core 2 eve 4 Core 4 eve 3 HWB2 eve 4 HWB4 eve 4 HWB5 eve 4 23

24 Speciaist competency 5: symptoms management continued (Leve 5) and eves: Core 1 eve 3 Core 2 eve 3 Core 5 eve 2 Core 6 eve 2 HWB2 eve 3 HWB5 eve 3 Experienced speciaist nurse (Leve 6) Provides information to the individua on the potentia variations in the pattern, severity and duration of their symptoms. Practice Performs accurate and comprehensive cinica assessments and generates appropriate treatment options. Monitors symptoms and recommends any changes in consutation with the patient and Consutant/Neuroogist /GP. Reviews whether activities to manage the patient s symptoms are effective for the individua. Accountabiity Documents and maintains accurate and coherent records. Liaises and communicates across primary and secondary care. and eves: Core 1 eve 3 Core 2 eve 3 HWB2 eve 3 HWB4 eve 3 HWB5 eve 3 IK2 eve 2 Expert speciaist nurse (Leve 7/8) 24

25 Speciaist competency 6: medicines management (Leve 5) Deveoping knowedge Deveops knowedge of the pharmacokinetic and pharmacodynamic properties of the drugs used in the management of PD. Recognises drugs that may be contraindicated in the management of PD, or drugs that can cause drug-induced Parkinsonism. Deveops knowedge of both ora and non ora therapies. Practice Identifies and agrees own roe in reation to drug management for the PwP. Provides support and information to the individua and their carers throughout the provision of medication. Ensures that heath and safety measures reevant to the administration of medication are undertaken. Reviews a reevant information about the individua s condition and symptoms. Aware how to access NBM/advice. Accountabiity Understands the principes of accountabiity in reation to drug management. Keeps accurate, egibe and compete records. Experienced speciaist nurse (Leve 6) Deveoping expertise Discusses and expains the drugs used in the management of Parkinson s disease to the PwP, their carers and other heath and socia care professionas. Shows awareness of the impications of functiona surgery on medicine management. Practice Performs accurate and comprehensive cinica assessments, and generates appropriate treatment options. Identifies the risks of medication, and expains any side effects to the individua. Estabishes whether the medication is being correcty administered as instructed, and identifies any reasons for noncompiance. Monitors drug therapy and recommends any changes in consutation with the PwP, consutant and neuroogist, to the GP. Encourages the individua to monitor their reaction to medication and to report any concerns or probems. Reviews the outcomes of the medication on the individua s symptoms and overa condition, incuding ensuring getting access to medication on time. Expert speciaist nurse (Leve 7/8) Demonstrating expertise Non-medica Independent prescriber working cosey with the oca medicines management team. Infuences prescribing poicy at oca and nationa eves. 18 Advises and supports heath professionas in medicine management pre- and postfunctiona surgery. Practice Works with the oca drugs and therapeutics committee to deveop protocos and shared care guideines. Coaborates and conducts consutation in partnership with the PwP, and deveops individua cinica management pans. Appies evidence base and oca formuaries in prescribing practice. Monitors prescribing practice through foow-up and within cinica management pan, and makes referra back to the independent prescriber where appropriate. 16 Conducts speciaist pre-and postsurgica assessments. Manages the titration of anti- Parkinson s medicines in reation to functiona surgery. 25

26 Speciaist competency 6: medicines management continued (Leve 5) and eves: Core 1 eve 3 Core 2 eve 3 Core 3 eve 2 Core 4 eve 2 HWB2 eve 3 HWB3 eve 1 Experienced speciaist nurse (Leve 6) Titrates anti-parkinson s medication, as per ocay agreed protoco, with the consutant. Identifies patients who may benefit from non ora therapies, and assists in the assessment process. Initiates Apomorphine/response test as per shared care guideines and oca protoco. Abe to titrate Duodopa and Apomorphine dose rates as prescribed. Awareness of emergency medication regime in event of non ora device faiure. Advise on NBM as per guideines. Accountabiity Documents and maintains accurate and coherent records. Liaises and communicates across primary and secondary care. and eves: Core 1 eve 3 Core 3 eve 2 Core 5 eve 3 HWB2 eve 3 HWB3 eve 2 HWB4 eve 3 HWB5 eve 3 IK eve 2 Expert speciaist nurse (Leve 7/8) Provides expert medicine management during pre- and post- functiona surgery assessment according to ocay agreed guideines/protocos. Awareness of MHRA aerts and impact on practice. Disseminate to team, and adapt practice accordingy. 17 Provides expert medicine management during pre- and post- functiona Duodopa assessment according to ocay agreed guideines/protocos. Deveop guideines, and impement pan for NBM management. Accountabiity Works within egisative framework within independent and suppementary nurse prescribing. Foows guidance set out in the NMC standards for medicine management. 18 Is responsibe for maintaining their continued professiona deveopment. and eves: Core 1 eve 4 Core 2 eve 4 Core 3 eve 3 Core 4 eve 4 Core 5 eve 3 HWB2 eve 4 HWB3 eve 3 HWB4 eve 4 HWB5 eve 4 26

27 Speciaist competency 7: referra to the mutidiscipinary team (MDT) (Leve 5) Mutidiscipinary iaison Identifies heath, socia, vountary, and independent sector staff with interest in Parkinson s. Estabishes MDT working reationships. Infuence and eadership Understands the roe of the PDNS and the roe of the surgica movement disorder speciaist nurse. Deveops an awareness of how own roe impacts on service deivery ocay to PwP. Professiona networking Identifies opportunities to join effective networking groups; for exampe the PDNSA and UK Parkinson s Exceence Network. and eves: Core 1 eve 3 Core 2 eve 3 Core 3 eve 2 Core 6 eve 2 HWB3 eve 1 Experienced speciaist nurse (Leve 6) Mutidiscipinary iaison Maintains and expands MDT working. Fosters coser working reationships with heath, socia, vountary and independent sectors. Infuence and eadership Communicates and promotes effectivey the roe of the PDNS/ surgica movement disorder speciaist nurse as a pivota member of the MDT. Deveops own eadership skis through recognised courses. Professiona networking Maximises the use of effective networking across socia and heath care boundaries. and eves: Core 1 eve 3 Core 2 eve 3 Core 4 eve 2 Core 5 eve 3 Core 6 eve 3 Expert speciaist nurse (Leve 7/8) Mutidiscipinary iaison Deveops new working practices with heath, socia, vountary and independent sectors. Infuence and eadership Infuences oca service provision by Parkinson s nursing eadership, and participates in mutidiscipinary projects. Deveops eadership skis of others through participation in eadership training and mentorship. Professiona networking Initiates new networking opportunities through meeting peope working in other speciaist areas. Participates on a nationa and internationa basis. and eves: Core 1 eve 4 Core 2 eve 4 Core 4 eve 4 27

28 Speciaist competency 8: education (Leve 5) Deveoping knowedge Attends educationa programmes for MDT, nursing, the vountary sector and other non-professiona groups in managing a aspects of Parkinson s. Participates in oca and nationa cinica networks, Joins regiona Parkinson s Exceence Network group. Joins regiona PDNS network meetings. Teaching Teaches within imitations of own Parkinson s knowedge. Identifies opportunities to deveop own earning needs for teaching and sharing knowedge. Use of evauation toos Responds to evauation/feedback on teaching sessions. Mentorship Makes effective use of a mentor to expore ideas and devise a persona deveopment pan. Teaching peope with Parkinson s disease Understands the possibe barriers to earning, and uses strategies to maximise and evauate earning. and eves: Core 2 eve 3 G1 eve 1 Experienced speciaist nurse (Leve 6) Deveoping expertise Initiates and deveops effective oca cinica networks, education programmes and discussion groups for across the heathcare sector. Teaching Shares speciaist Parkinson s knowedge and evidence-based practice in a variety of settings. Uses a range of knowedge sources to deveop own cinica practice and that of others, using forma teaching and/or writing for oca pubications. Undertakes teaching at higher education institutions and on undergraduate and graduate training programmes. Use of evauation toos Uses a range of education evauation toos to find out the opinions of others. Incorporates feedback into future sessions/courses. Mentorship Acts as a mentor to PDNSs new in post. Teaching PwP Promotes the education of peope with Parkinson s by encouraging patients to take responsibiity for heath and webeing, emphasising the concept of weness in iving with Parkinson s. Runs support/education groups for PwP. Expert speciaist nurse (Leve 7/8) Demonstrating expertise Identifies and responds to the earning needs of the MDT, concentrating on experienced coeagues who need to deveop advanced knowedge and skis. Deveops and sustains productive partnerships, paying a part in the deveopment of managed cinica networks and educationa programmes. Teaching Leads on the deveopment of regiona higher education institutions. Ensures incusion of Parkinson s training in undergraduate and graduate training programmes. Disseminates knowedge by writing for pubications and speaking at conferences. Is acknowedged as a vauabe resource for Parkinson s teaching and expertise. Use of evauation toos Promotes innovative ways to optimise earning. Uses evauation to deveop new programmes for high-eve practice. Mentorship Acts as a roe mode at oca, nationa and internationa eve to hep others to chaenge practice and promote professiona deveopment. 28

29 Speciaist competency 8: education continued (Leve 5) Experienced speciaist nurse (Leve 6) and eves: Core 1 eve 3 Core 2 eve 3 G1 eve 2 Expert speciaist nurse (Leve 7/8) Teaching peope with Parkinson s Leads the deveopment of oca and regiona education initiatives for PwP, and participates in the deveopment of nationa education initiatives that incorporate the concept of the expert patient. Maximises the use of deveoping technoogies as they become avaiabe, for exampe direct access between cinicians and patients via web-based systems. and eves: Core 1 eve 4 Core 2 eve 4 G1 eve 4 29

30 Speciaist competency 9: research and audit (Leve 5) Understanding research Understands what is meant by evidence informed care. Accesses evidence reevant to Parkinson s management and shares this resource with others. Undertaking research Supports existing mutidiscipinary Parkinson s research in the oca area where there is a recognised need for speciaist nursing input. Patient trias Expains to patients the meaning of common terms and concepts used in research methodoogies (for exampe, randomisation, bind trias, informed consent, pacebos), and what these may mean for them. Audit Identifies components of PDNS/ surgica movement disorder speciaist nurse roe that are ikey to contribute most to quaity outcomes in oca service deivery. Deveops awareness of audit toos and identifies support to undertake audit. Participates in the Nationa Parkinson s UK audit. and eves: Core 1 eve 3 Core 2 eve 3 Core 4 eve 2 Core 5 eve 2 IK2 eve 2 Experienced speciaist nurse (Leve 6) Understanding research Uses critica appraisa skis to differentiate between research that wi improve practice and promote change on an individua and organised eve. Undertaking research Contributes to the design and practica impementation of oca mutidiscipinary PD research projects, representing a speciaist nursing perspective. Patient trias Enabes patients to have reaistic expectations about participating in research and evidence-based treatment/ifestye changes. Audit Carries out audit of key aspects of own service using a range of approaches; for exampe, standards, patient satisfaction, compaints monitoring and quantitative data, such as teephone advice and response times. Undertakes Nationa Parkinson s UK Audit and eves: Core 2 eve 3 Core 4 eve 2 Core 5 eve 3 HWB1 eve 3 HWB4 eve 3 IK2 eve 3 G2 eve 1 Expert speciaist nurse (Leve 7/8) Understanding research Infuences poicy at organisationa, regiona and nationa eves by highighting evidence in support of proposed practice/service deveopments in the fied of Parkinson s. Undertaking research Identifies mutidiscipinary research questions reevant to daiy practice and, with supervision, designs, carries out and reports on these projects. Patient trias Uses in-depth cinica and research knowedge to empower patients to make we-informed decisions about participating in Parkinson s research. Audit Contributes to the design of PDNS and surgica movement disorder speciaist nurse data as part of mutidiscipinary cinica audit projects at organisationa, oca and nationa eve. Organises the Nationa Parkinson s UK audit for the team. Reviews outcomes of audits and adapts practice accordingy. and eves: Core 4 eve 4 Core 5 eve 3 HWB4 eve 4 IK2 eve 3 IK3 eve 4 G2 eve 3 30

31 Speciaist competency 10: management through the four stages (Leve 5) Deveoping knowedge Shows awareness of the fourstage management concept, and the potentia needs of patients at each stage: diagnosis maintenance compex paiative care. Undertakes interventions expected of a registered nurse at each stage, consistent with evidence-based practice, own scope of practice and egisation. Appies skis and knowedge to meet individuas changing needs. Uses a fu range of nursing strategies to reieve the psychoogica and spiritua impact of the physica and emotiona aspects of iness on individuas and famiies throughout each stage. Acts on knowedge of the key interventions, treatments and therapies appropriate to the cient group. Undertakes monitoring and assessment as requested. Demonstrates awareness of risk factors and has active istening skis. Anticipation of crises. Awareness of anticipatory care guideines. and eves: Core 1 eve 3 Core 2 eve 3 HWB2 eve 3 HWB3 eve 1 HWB5 eve 3 HWB7 eve 3 Experienced speciaist nurse (Leve 6) Deveoping expertise Makes decisions about priorities in each stage in coaboration with PwP and other team members, and acts as a named contact. Monitors the assessment and care panning processes provided by the team, and faciitates others in the deveopment of competence in management processes. Demonstrates knowedge of theoretica frameworks and educationa phiosophies underpinning behaviour change, and understanding of biophysica and psycho-socia factors affecting sef-management. Deveops and ensures deivery of educationa materia and supportive networks that foster empowerment. Works with PwP to faciitate ifestye changes in response to changes in condition or circumstances. Estabish anticipatory care Impements anticipatory care guideines. Anticipation of crisis Orders tests and speciaist investigations, and using risk assessment, history and interpretation skis, then acts on resuts. Monitoring the condition Infuences therapeutic decisions, and demonstrates counseing skis. Deveops guideines/protocos, and shows proficiency in deveoping and deivering education. Expert speciaist nurse (Leve 7/8) Demonstrating expertise Advises on expert management, particuary in highy distressing circumstances. Deveops speciaised programmes of care, and highy speciaised advice. Identifies service deficits and deveops a strategic pan for the service. Works in coaboration with higher education institutes and other education providers to meet education needs. Initiates and eads research and promotes evidence-based practice. Deveops best practice, for exampe. through eadership. and eves: Core 1 eve 4 Core 2 eve 4 Core 4 eve 4 Core 5 eve 3 G1 eve 4 G5 eve 4 31

32 Speciaist competency 10: management through the four stages continued (Leve 5) Experienced speciaist nurse (Leve 6) Expert speciaist nurse (Leve 7/8) Manages and coordinates individua patient care and education, and negotiates persona care pans. Provides or refers for psychoogica support as required. and eves: Core 1 eve 3 Core 2 eve 3 Core 5 eve 3 HWB1 eve 2 HWB2 eve 3 HWB4 eve 3 HWB5 eve 3 G1 eve 2 32

33 Speciaist competency 10: management through the four stages Professiona and persona deveopment (Leve 5) Refective practice Recognises the importance of cinica supervision and attends on a reguar basis. Identifies critica incidents from which earning wi occur. Ensures own supervision needs are met at an appropriate eve with identified mentor. Adheres to NMC revaidation process. Deveop knowedge Attends/has access to recognised training course for management of PwP. Recognises the importance of networking. Ensures protected time for study and peer networking. Uses refection to prioritise areas for persona deveopment, formuating a persona deveopment pan with ine manager and mentor. and eves: Core 2 eve 3 Experienced speciaist nurse (Leve 6) Refective practice Improves the quaity of the service through refection on positive and negative cinica experiences. Provides mentorship for ess experienced nurses, and support with revaidation process (NMC). Deveop knowedge Maintains professiona deveopment through access to nationa study days and courses. Shares knowedge and best practice through participation in oca and nationa speciaist networks. and eves: Core 2 eve 3 Expert speciaist nurse (Leve 7/8) Refective practice Initiates and provides skied supervision for members of team. Deveops action earning sets. Supports and guides other nurse mentors. Supports NMC revaidation process for sef and team members. Deveop knowedge Leads a managed cinica network to educate. Shares experience and knowedge at regiona and nationa eves. Deveops skis in ecturing and faciitating for Parkinson s dipoma and degree courses. Working towards masters or wiing to undertake if appropriate. Accesses and participates in study days at nationa and internationa eve. Infuences poicy at oca and nationa eves. and eves: Core 2 eve 4 33

34 Speciaist competency 11: assessing and managing compications Psychoogica probems (Leve 5) Deveoping knowedge Recognises psychoogica probems, and reports to speciaist nurse and/or medica practitioner. Documents and reports any abnorma findings. Shows awareness of how this might affect PwP and their carer, and advises accordingy. and eves: Core 1 eve 3 Core 6 eve 2 HWB3 eve 1 Experienced speciaist nurse (Leve 6) Deveoping expertise Assesses menta heath status using reevant toos such as MOCA. Provides support and advice to patients and carers to hep them dea with emotiona probems. Refers appropriatey to the menta heath team if menta heath probems are found, and works with the team. Educates carers reating to the management of neuro-psychiatric symptoms, incuding ICB and eves: Core 1 eve 3 Core 2 eve 3 HWB2 eve 3 HWB4 eve 3 IK2 eve 2 Expert speciaist nurse (Leve 7/8) Demonstrating expertise Advises other members of the MDT about the management of neuro-psychiatric symptoms, incuding drug treatment. Pans and manages the care of patients with psychiatric compications using others for support and advice when needed. Deveops oca and nationa guideines for the management of the neuro-psychiatric probems associated with Parkinson s. Lectures/educates peers and coeagues at oca and nationa eves. Recognises when end-of-ife care is most appropriate. Supports the patient, famiy, carers and coeagues during this process. and eves: Core 1 eve 4 Core 2 eve 4 Core 4 eve 4 Core 5 eve 4 Core 6 eve 4 HWB2 eve 4 HWB3 eve 3 HWB5 eve 4 G1 eve 4 34

35 Speciaist competency 11: assessing and managing compications Motor and non-motor fuctuation (Leve 5) Deveoping knowedge Shows awareness of occurrence of motor and non-motor fuctuations and end-of-dose probems. Shows awareness of appropriate referra system for probems. Demonstrates an awareness of the physioogy reating to motor and non-motor fuctuations. Under supervision identifies and articuates patient needs, and suggests an appropriate ifestye change. Demonstrates abiity to evauate current practice and refer back to consutant/neuroogist/gp as necessary. Shows awareness of the toos, eectronic equipment avaiabe to monitor motor and non-motor fuctuations. and eves: Core 1 eve 3 Core 2 eve 3 HWB1 eve 1 HWB2 eve 3 HWB4 eve 2 HWB5 eve 3 IK2 eve 2 Experienced speciaist nurse (Leve 6) Deveoping expertise Demonstrates abiity to work within set guideines and protocos for the management of motor and non-motor fuctuations. Demonstrates abiity to interpret assessment toos and eectronic equipment and gives appropriate advice to patients with suggested ifestye changes or treatment changes (within agreed guideines or protocos). Demonstrates abiity to supervise and teach junior coeagues about motor and non-motor fuctuations. Demonstrates abiity to communicate the issues reated to motor and non-motor fuctuations with patient, carer, heath and socia care professionas. and eves: Core 1 eve 3 Core 2 eve 3 Core 5 eve 3 HWB2 eve 3 HWB5 eve 3 IK2 eve 2 G6 eve 1 Expert speciaist nurse (Leve 7/8) Demonstrating expertise Demonstrates abiity to interpret the findings of investigations independenty. Demonstrates abiity to articuate the evidence base and changes practice accordingy. Accepts referras from other nursing and medica staff. Identifies appropriate services and products to meet patients needs. Faciitates the deveopment of new services to meet patients needs. Deveops training programmes, guideines and protocos to manage motor and non-motor fuctuations in PwP. and eves: Core 1 eve 4 Core 4 eve 3 Core 5 eve 4 IK2 eve 2 HWB4 eve 4 HWB5 eve 4 G1 eve 4 35

36 Speciaist competency 11: assessing and managing compications Promoting independence (Leve 5) Deveoping knowedge Knowedge base Demonstrates knowedge of the physioogica socia and spiritua needs of PwP, and the abiity to recognise and describe signs of common probems affecting the peope with Parkinson s that may compromise sef-care. Interventions Uses advocacy, interpersona and istening skis to ensure PwP are abe to express their needs and receive appropriate care. Maintains safety, privacy, respect and dignity of PwP. Demonstrates reevant and current knowedge of heath promotion issues. Assesses the person s abiity to manage their own care independenty and/or refers to ensure their needs are met. Introduces concept of anticipatory care, foowing oca guideines. Management Provides support and advice for PwP to be cared for in the environment of their choice, adapted to suit their needs. Engages in muti-agency coaboration, and paces the patient and the carer at the centre of decision making. Demonstrates effective communication skis with PwP/ carer and heath and socia care professionas. Experienced speciaist nurse (Leve 6) Deveoping knowedge Knowedge base In caring for PwP identifies the physica, socia, psychoogica cutura and spiritua needs arising from norma ageing. Ensures the patient is given the information they need to make informed care decisions. Interventions Provides information and support to promote and encourage patient empowerment and decision-making reating to care and support. Undertakes a comprehensive hoistic assessment of any changes in a patient s condition and refers appropriatey to the MDT. Demonstrates abiity to impement treatment regimens competenty within agreed guideines or protocos. Impements knowedge and skis of effective heath promotion to meet the needs of PwP. Management Engages and deveops muti-agency coaboration across heath and socia care. Demonstrates understanding of ega, mora and ethica issues reating to PwP. Identifies, acknowedges and promotes activities that benefit PwP, incuding both pharmacoogica and compementary therapies. Expert speciaist nurse (Leve 7/8) Deveoping knowedge Knowedge base Criticay appraises the avaiabe research and evidence base to ensure best practice in managing PwP. Activey identifies areas for research into sef-care, or inabiity for PwP to sef-care. Participates in deveoping and pubishing the evidence base and best practice guideines. Interventions Criticay assesses, pans, impements and evauates panned care that incorporates the hoistic needs of PwP. To achieve best outcomes, initiates decision-making based on expertise and experience. Initiates and accuratey interprets a range of investigations reating to the condition and needs of the patient. Demonstrates autonomy of practice and decision-making in meeting the needs of PwP. Management To deveop and improve care for PwP. Contributes and coaborates at oca and nationa eves to deveoping and impementing 19 and other government pans, poicies and strategies. Criticay anayses the ega, mora and ethica issues reating to PwP. Effectivey champions the needs of PwP through patient advocacy and active empowerment. 36

37 Speciaist competency 11: assessing and managing compications Promoting independence continued (Leve 5) and eves: Core 1 eve 3 Core 2 eve 3 Core 3 eve 2 Core 6 eve 3 HWB1 eve 1 HWB2 eve 3 HWB3 eve 1 Experienced speciaist nurse (Leve 6) and eves: Core 1 eve 3 Core 2 eve 3 Core 4 eve 2 Core 5 eve 3 Core 6 eve 3 HWB1 eve 2 HWB2 eve 3 HWB4 eve 3 HWB5 eve 3 Expert speciaist nurse (Leve 7/8) and eves: Core 1 eve 4 Core 2 eve 4 HWB2 eve 4 HWB4 eve 4 HWB5 eve 4 IK2 eve 3 K3 eve 4 G2 eve 3 37

38 Speciaist competency 11: assessing and managing compications Concurrent iness (Leve 5) Identification Communicates with hospita wards how to contact the PDNS if required to assess a patient with Parkinson s whist in hospita. Identifies signs of concurrent iness and reports to appropriate medica or speciaist nursing staff. Documents and reports abnorma findings, and shows awareness of how concurrent iness might affect PD and advises accordingy. In-patient care acute setting Environment Abe to advise ward staff on appropriate adaptation of the environment to care for PwP. Good interpersona and communication skis with a heath and socia care professionas. Abiity to refer patients to the appropriate MDT member to ensure the patient receives hoistic in-patient care. Practises and advocates respect for privacy and dignity of the patient whie in hospita. Provides information and support to the PwP and the famiy/carer. Demonstrates abiity to undertake a genera hoistic assessment of the PwP. Experienced speciaist nurse (Leve 6) Identification Initiates appropriate preiminary investigations, and takes a comprehensive patient assessment and history. Knows and uses appropriate referra systems, and gives advice on continuation of current medication. In-patient care acute setting Environment Takes an active roe in the risk assessment process and identifies risk assessment cinica indicators. Undertakes environmenta and equipment audit and reports findings (if appropriate). Shows exceent interpersona and communication skis with a heath and socia care professionas. Demonstrates abiity to provide comprehensive patient management advice to nonspeciaist and junior staff. Uses a hoistic nursing mode appropriate to the care of PwP to assess, pan, impement and evauate in-patient nursing care. Shows an understanding of the physioogica signs, symptoms and the risks associated with an emergency admission of PwP, and advises on Parkinson s care in hospita admissions/procedures, where the PwP is NBM. Expert speciaist nurse (Leve 7/8) Identification Provides expert advice on compex cases. Leads the deveopment of oca and regiona initiatives to ensure PwP are managed effectivey in hospitas. In patient care acute setting Interpersona skis Leads and deveops in-patient nursing management and reviews, advises or aters patient treatment pans in coaboration with MDT. Is responsibe for the cinica management of PwP and advises on the future direction and management of services. Identifies service deficits and deveops strategic pans for the service. Writes and reviews oca protocos/guideines in ine with nationa recommendations. Reviews medication and ensures appropriate changes are made. 25 and eves: Core 1 eve 4 Core 3 eve 4 Core 4 eve 4 Core 5 eve 4 HWB3 eve 3 IK2 eve 3 G5 eve 4 G6 eve 4 38

39 Speciaist competency 11: assessing and managing compications Concurrent iness continued (Leve 5) Experienced speciaist nurse (Leve 6) Expert speciaist nurse (Leve 7/8) and eves: Core 1 eve 3 Core 6 eve 3 HWB1 eve 1 HWB2 eve 3 HWB3 eve 1 HWB4 eve 2 HWB5 eve 3 Troube-shoots and responds to probems reating to the care of PwP in hospita and responds to queries from ay peope and other heath care professionas about hospita care. Deveops or maintains oca guidance for the care of PwP in hospita. Sets and maintains standards of care and educates nurses and other carers about caring for a PwP in hospita, and the importance of getting medication on time. and eves: Core 1 eve 3 Core 2 eve 3 Core 3 eve 2 Core 5 eve 3 HWB2 eve 3 HWB3 eve 2 HWB4 eve 3 HWB5 eve 3 HWB6 eve 3 G1 eve 2 39

40 Speciaist competency 12: mobiity and fas (Leve 5) Deveoping knowedge Demonstrates awareness of contributory factors that cause PwP to fa. Acts on knowedge of the key interventions, treatments and therapies appropriate to the cient group. Undertakes monitoring and assessment as requested. Demonstrates awareness of risk factors. Demonstrates active istening skis. Maintains basic competence in fas assessment and prevention. Shows awareness of oca fas prevention programmes. Guidance on safe compassionate care for frai oder peope. 20 and eves: Core 1 eve 3 Core 2 eve 3 Core 3 eve 2 HWB1 eve 1 HWB2 eve 3 HWB3 eve 1 Experienced speciaist nurse (Leve 6) Deveoping expertise Case/risk identification Identifies the physica, socia, psychoogica probems that may contribute to PwP. Interventions Undertakes a comprehensive hoistic assessment in reation to any changes in a patient s condition, and makes any appropriate referras to the MDT. Offers mutifactoria fas assessment in conjunction with MDT, incuding: fas history gait baance mobiity musce weakness perceived functiona abiity fear of faing visua impairment cognitive impairment medication review home hazards continence assessment. Engages and deveops mutiagency coaboration and cooperation across heath and socia care for the assessment and prevention of fas. Patient education Encourages the participation of peope with Parkinson s in fas prevention programmes, incuding education and information giving. and eves: Core 1 eve 3 Core 2 eve 3 HWB1 eve 2 HWB2 eve 3 Expert speciaist nurse (Leve 7/8) Demonstrating expertise Leads the deveopment of oca and regiona initiatives to ensure PwP are managed effectivey by the MDT. Identifies service deficits and deveops strategic pan for the service. Works in coaboration with higher education institutes, and other education providers, to meet education needs of a staff. Writes and reviews oca protocos/guideines in ine with nationa recommendations. Deveops and monitors the impementation of integrated care pathways for fas identification and management in Parkinson s. and eves: Core 1 eve 4 Core 3 eve 4 Core 4 eve 4 Core 5 eve 4 G1 eve 4 40

41 Speciaist competency 13: functiona surgica management (Leve 5) Surgery: pre/post-operation Shows awareness of patient journey through functiona surgery. Prepares patient for functiona surgery foowing ocay agreed protoco. Maintains patient safety with an awareness of potentia compications foowing DBS surgery; for exampe, infection, haemorrhage or confusion. Foows guideines for patient management foowing functiona surgery and documents/reports events appropriatey. Programming Deveops an awareness of the patient programmer in reation to deep brain stimuation (DBS) system. Shows awareness of potentia adverse effects due to the patient programmer/dbs. Awareness of potentia ifestye and heath care impications for patients due to the DBS system. and eves: Core 1, 2, 3 eve 3 HWB6 eve 3 HWB7 eve 3 Experienced speciaist nurse (Leve 6) Aware of seection criteria for non-ora therapies and criteria for entry to DBS programmes to support the patient in this decision process. Knowedge of communication and referra process for patients suitabe for DBS oca to your area. Surgery: pre/post-operation Performs and assists in the coordination for preparing the patient for functiona surgery. Understands the significance/ impications of compications due to the DBS system, and reports these in an appropriate and timey fashion. Manages the patient in reation to their Parkinson s and DBS surgery to promote best patient outcomes. Programming Knows where to refer when battery needs changing Deveops an understanding of the patient programmer in reation to the DBS system. Capabe of assessing battery interrogation. Aware of possibe side effects and work towards recognising adverse systems. Knowedge of potentia ifestye changes. Contact detais of oca DBS centre avaiabe and appropriate communication inks are in pace. Expert speciaist nurse (Leve 7/8) Surgery: pre/post-operation Advises and counses patients pre- and post-dbs surgery. Deveops guideines, protocos and care pathways for oca and nationa use in reation to preand post-procedures for DBS surgery. Educates heath professionas about compications reated to DBS surgery. Assesses and supports the patient through the various stages of the patient s surgica journey. Deveops best practice guideines to ensure patient safety, and promotes optima care to ensure best patient outcomes. Programming Deveops and understanding of the patient programmer. Shows awareness of potentia adverse effects due to the patient programmer/dbs. Programming DBS system as instructed by senior nurse or medica coeagues. Recognises side effects of stimuation, and reports to senior staff/centre accordingy. Provides information to the patient/carer about the interaction between DBS and medication. Demonstrates abiity to teach the patient/carer how to use the patient programmer, where appropriate. 41

42 Speciaist competency 13: functiona surgica management continued (Leve 5) Experienced speciaist nurse (Leve 6) Expert speciaist nurse (Leve 7/8) and eves: Core 1, 2, 3 eve 3 HWB1 eve 2 HWB3 eve 2 HWB4 eve 3 HWB7 eve 3 Documents and reports a effects of the DBS using ocay agreed documentation. Understands the importance of educating the patient about potentia ifestye and heath care 21, 22, 23 impications of DBS. and eves: Core 1, 2, 3, 4, 5 eve 4 HWB1 eve 3 HWB3 eve 4 HWB4 eve 4 HWB6 eve 4 HWB7 eve 4 G1 eve 4 42

43 References 1. Parkinson s UK (Web) About Parkinson s (cited March 2016). Avaiabe from content/what-parkinsons 2. Department of Heath (1999) Making a difference: strengthening the nursing, midwifery and heath visiting contribution to heath and heathcare, London: DH. 3. Department of Heath (2004) The NHS Knowedge and Skis Framework (NHS KSF) and the Deveopmenta Review process, London: DH. 4. Nursing and Midwifery Counci (2015a) Revaidation: how to revaidate with the NMC. Requirements for renewing your registration, London: NMC. Avaiabe from: sitedocuments/revaidation/how-to-revaidatebooket.pdf (Accessed 31 March 2016) (Web). 5. Nationa Institute for Heath and Cinica Exceence (2006) Parkinson s disease, diagnosis and management in primary and secondary care, London: NICE. 6. Scottish Intercoegiate Guideines Network (2010) Diagnosis and pharmacoogica management of Parkinson s disease, Edinburgh: SIGN. 7. Roach M (1992) The human act of caring: a bueprint for the heath professions, Ottawa: Canadian Hospita Association Press. 8. Nursing and Midwifery Counci (2015b) The Code: professiona standards of practice and behaviour for nurses and midwives, London: NMC. 9. Department of Heath (1999) Agenda for change: modernising the NHS pay system, DH: London. 10. Department of Heath (2000) The NHS pan: a pan for investment, a pan for reform, London: DH. 11. Department of Heath CNO s Directorate (2006) Modernising nursing careers setting the direction, London: DH. 12. Skis for Heath (2005) Career framework for heath, London: SfH. 13. Benner P (1982) From novice to expert, The American Journa of Nursing, 82, pp MacMahon DG and Thomas S (1998) Practica approach to quaity of ife in Parkinson s disease: the nurse s roe, Journa of Neuroogy, 245 Supp 1:S Roya Coege of Nursing (2009) Integrated core career and competence framework for registered nurses, London: RCN. Avaiabe from: uk/ data/assets/pdf_fie/0005/276449/ pdf (Accessed 31 March 2016) (Web). 16. Association of the British Pharmaceutica Industry (2012) Code of practice for the pharmaceutica Industry 2012, London: ABPI. 17. Nationa Prescribing Centre (2001) Maintaining competency in prescribing: an outine framework to hep nurse prescribers, Liverpoo: NPC. 18. Nursing and Midwifery Counci (2010) Standards for medicines management, London: NMC. 19. Department of Heath (2005) Nationa Service Framework for ong-term conditions, London: DH. Avaiabe from: en/pubicationsandstatistics/pubications/ PubicationsPoicyAndGuidance/DH_ (Accessed 31 March 2016) (Web). 20. NHS Engand (2014) Safe, compassionate care for frai oder peope using an integrated care pathway: practica guidance for commissioners, providers and nursing, medica and aied heath professiona eaders, London: DH. Avaiabe from: wp-content/upoads/2014/02/safe-comp-care.pdf (Accessed 31 March 2016) (Web). 21. Odin P, Chaudhuri R et a. (2015) Coective perspectives on non-ora medication approaches for the management of cinicay reevant unresoved issues in Parkinson s disease, Parkinsonism & Reated Disorders, 21(10), pp Worth PF (2013) How to treat Parkinson s disease in 2013, Cinica Medicine Journa, 13(1), pp Surgica Movement Disorder Nurse Steering Group (2004) The roe of the surgica movement disorder nurse speciaist, London: SMDNSG. 24. Schuepbach WMM et a. (2013) Neurostimuation for Parkinson s disease with eary motor compications, The New Engand Journa of Medicine, 368, pp Epiepsy Speciaist Nurse Association (2012) The adut epiepsy speciaist nurse competency framework, London: ESNA. Avaiabe from: org.uk/sites/epiepsy/fies/professionas (Accessed 31 March 2016) (Web). 26. UK MSSNA MS Research Trust and Roya Coege of Nursing (2003) Competencies for MS speciaist nurses, MS Research Trust, Letchworth Garden City. 43

44 Usefu resources Interna Line manager. Practice deveopment team or cinica education ead within your organisation. Externa Parkinson s Disease Nurse Speciaist Association (PDNSA) UK Parkinson s Exceence Network Parkinson s disease in over 20s: diagnosis and management Guidance and guideines/nice Diagnosis and pharmacoogica management of Parkinson s disease (SIGN Guideine No113) NHS Knowedge and Skis Framework (NHS KSF) and Deveopment Review Guidance/Department of Heath Skis for Heath RCN Institute Practice Deveopment RCN Deveoping integrated heath and socia care services for ong term conditions (2006) RCN Pubications Association for Prescribers Nationa Prescribing Centre (2012) A singe competency framework for a prescribers. Charities Parkinson s UK Cure Parkinson s Trust Mutipe System Atrophy Trust Progressive Supranucear Pasy Integrated Neuroogica Services Cross Party group for Neuroscience (Waes Neuroogica Aiance) Neuroogica Aiance of Scotand (Scotand Neurosciences Counci) Neuroscience Ireand 44

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48 The Parkinson s Disease Nurse Speciaist Association (PDNSA) acts as a nationa resource and network for nurses to share knowedge, expertise and best practice about Parkinson s disease and its management. The UK Parkinson s Exceence Network is the driving force for improving Parkinson s care, connecting and equipping professionas to provide the services peope affected by the condition want to see. parkinsons.org.uk/exceencenetwork The UK Parkinson s Exceence Network is supported by Parkinson s UK. Parkinson s UK is the operating name of the Parkinson s Disease Society of the United Kingdom. A company imited by guarantee. Registered in Engand and Waes (948776). Registered office: 215 Vauxha Bridge Road, London SW1V 1EJ. A charity registered in Engand and Waes (258197) and in Scotand (SC037554). Te Hepine emai heo@parkinsons.org.uk The RCN represents nurses and nursing, promotes exceence in practice and shapes heath poicies Pubication code: Pubished by the Roya Coege of Nursing 20 Cavendish Square London W1G 0RN RCN Onine RCN Direct