A Specialist Palliative Care Nurses Competency Framework Helen Butler Education Team Leader Mercy Hospice Auckland

Transcription

1 A Specialist Palliative Care Nurses Competency Framework Helen Butler Education Team Leader Mercy Hospice Auckland

2 The aim of this session To refresh our memories about what a competency is To give a bit of context look at the history of specialist palliative care competencies for nurses in NZ To outline why I developed this specialist nursing competency framework To show you what the framework looks like and identify how it can be used

3 A competency is: a cluster of related knowledge, skills and attitudes that affects a major part of one s job (a role or responsibility), that correlates with performance on the job, that can be measured against well-accepted standards, and that can be improved via training and development McConigley R, et al (2012)

4 A long time coming.

5 The idea ignited.

6 The idea grew.

7 But needed to percolate.

8 A call to action.

9

10 An amalgamation of existing competency frameworks New Zealand Nursing Council Requirements A National Professional Development Framework for Palliative Care Nursing Practice in Aotearoa New Zealand Ireland Palliative Care Competence Framework WDHB Primary Care Competencies ADHB PDRP Competency Requirements Hospice North Shore Clinical Knowledge and Skills (Palliative Care) Palliative Care Nurses Australia Competency Standards for Specialist Palliative Care Nursing Practice Royal College Nursing A framework for nurses working in specialist palliative care

11 Aim and objectives of these competencies To enable demonstration of safe, consistent, compassionate, evidence based practice To provide a framework which illustrates what we do as specialist palliative care nurses To outline a minimum standard of care To support palliative nurse s professional development within their chosen specialty

12 How can the framework be used As an employment screen Identify what level the person is practicing at (an induction screen) To guide a nurses PDRP As part of a performance appraisal Planning individual career pathways

13 The Levels Level 1 - Developing A nurse new to palliative care, new to nursing (NETP) or in a return to practice programme Level 2 - Competent A practitioner with a wide range of nursing experience who is showing emerging skill in palliative care provision Level 3 - Proficient An experienced practitioner who routinely uses their specialist skills Level 4 - Expert An experienced nurse working within specialist palliative care who leads and supports the team whilst developing practice

14 Level 1 Level 2 Level 3 Level 4 Recognises the cultural uniqueness of individuals and their families/whānau and demonstrates the provision of sensitive and culturally appropriate nursing care to those with a life-limiting illness. Demonstrates the ability to gain cultural support and assistance from appropriate sources if/when needed. Has developed a holistic overview of the client. Applies the principles of cultural safety in own nursing practice. Assists the person to gain appropriate support and representation from those who understand their culture, needs and preferences. Facilitates participation in religious/spiritual and cultural practices as appropriate. Respects the patients values and beliefs e.g. the nurse changing her/his approach to meet their needs, the nurse avoiding imposing her/his beliefs on the patient, recognising the power imbalance between the nurse and patients and their family. Initiates learning about safe cultural practice. Consults with members of cultural and other groups as requested and approved by the client. Demonstrates ability to communicate effectively with individuals and families/whānau from diverse cultures and different backgrounds, using professional interpreters where necessary and/or assistive communication technology where necessary. Consistently provides care in a manner that is acceptable to the patient by adjusting own approach, acts to reduce power imbalance between self and patient family/whanau, accesses relevant cultural resources. Alters practice according to cultural needs. Constructively challenges practice were issues arise of cultural encounters. Resolves challenging care situations using cultural knowledge and cultural skills. Role models cultural sensitivity at all times. Able to modify communication style to facilitate communication with individuals with a range of communication impairments or seek assistance if needed. Recognises impact of own culture on nursing care/interactions with patient, family/whanau; acts to eliminate power imbalance between self and patients/families/whanau, uses and guides others in the use of cultural best practice principles, support others to access relevant cultural resources. Consistently demonstrates critical thinking, prioritising and co-ordinating an individuals care in consultation with family/whanau. Facilitates activities to monitor and improve cultural safety. Practises in a way that acknowledges the impact a life-limiting illness has on individual and their family/ whānau, including recognising their culture, spirituality, dignity, beliefs and rights.

15 Level 1 Level 2 Level 3 Level 4 Recognises effective, patientcentred communication is a core component to providing quality palliative care. Communication is clear and complete, open, inclusive and honest. Displays basic communication skills including active listening and empathy. Aware of the important role nonverbal behaviours and attributes play in effective communication. Utilises resources appropriately to address impediments to communication that may result from disease, hearing, speech, language etc. Able to be with patients and families/whanau helping them to interpret bad news and listening to their emotional responses to such information. Aware that there are often differences in communication needs between patients and family/whanau members. Provides seamless and effective communication between the inpatient team and community team(s). Recognises the opportunity by picking up cues to hold deeper discussions relating to psychological, emotional or spiritual issues. Able to positively influence patient care through effective communication. Displays intermediate personcentred communication skills including compassion. Confidently facilitates and manages interactions with patients and family/whanau Demonstrates ability to enlist the skills of the multidisciplinary team/colleagues to enhance and support communication with the person and their family/whanau. Able to effectively use translators for non-english-speaking patients to facilitate communication. Demonstrate an awareness of the need for communicating with primary care teams and other teams that may impact on the delivery of care to people with lifelimiting conditions and their families Co-ordinates team input to meet the needs of the patients/ clients/ service users. Communicates effectively based upon patient's underlying knowledge of their condition, and able to address direct patient questions, denial, collusion, and anger. Displays patient-centred communication as part of everyday practice. Creates an empowering and affirming environment whilst working with patients and their family/whanau enabling them to make their own choices. Demonstrates ability to communicate sensitively and clearly about advance care planning with the person, family/whanau and the wider interdisciplinary team. Provides patients with appropriate and accurate information that will facilitate informed decision-making on all aspects of care. Able to provide information to guide the multidisciplinary team to respond and manage complex situations. Highlights and advocates for the changing needs and preferences of the patient and family/whānau over time. Negotiates with various team members to get a positive outcome. Calm, confident in manner, able to provide reassurance to healthcare team. Demonstrates defusing skills. Displays key skills of patientcentred communication including information exchange, managing uncertainty, enabling patient selfmanagement, responding to emotions, fostering the clinician patient relationship. Demonstrates advanced communication skills with patients and families/whanau. Demonstrate leadership through the promotion of effective intra and interdisciplinary team communication in the palliative care setting. Creates an environment that allows nurses to develop therapeutic relationships and enables more inexperienced staff to share their views of patient issues to the wider team. Through effective communication facilitates others understanding of links between ethical and clinical reasoning. Conducts team building activities, fostering attentiveness, skill and collaboration. Teaches communication skills in formal settings.

16 Able to assess a person with a lifelimiting condition and recognises the role of palliative care in enhancing that person s care. Demonstrates ability to assess and manage common symptoms associated with life-limiting conditions. Uses clinical assessment and physical examination skills to assess patient status. Able to assess changes in patient status and reports appropriately. Seeks guidance from senior staff. Able to assess the person s current understanding of their health status. Recognises risk of infection and implements infection control measures and refers to appropriate professionals. Undertakes a comprehensive nursing assessment and delivers nursing care that incorporates all aspects of the person physical (te taha tinana), spiritual (te taha wairua), emotional (te taha hinengaro) and social (te taha whanau). Can carry out a comprehensive holistic nursing assessment of a patients, their families/whanau within the palliative care setting. Physical Psychological Spiritual Social Exhibits ability to apply a range of assessment tools to gather information. Demonstrates ability to assess and manage common symptoms associated with life-limiting conditions using guidelines, standard protocols of care and in context of current scope of practice. Uses organisational policy and procedures to provide care, seeking advice when needed. Demonstrates advanced physical examination and diagnostic reasoning skills, links changes in patient to sound clinical evidence and data analysis including lab test results, x-rays etc. Skilled in needs and risk assessment, planning and evaluating care. Identifies priorities or concerns for the individual and their carers, taking account of the individual s coping strategies and the person s perception of their diagnosis. Able to recognise/ identify the signs and symptoms of restlessness, confusion, delirium, terminal restlessness using screening tools and diagnostic reasoning. Identifies the impact of changing clinical status on functional ability, modifying practice and adhering to revised documented advice. Can anticipate (where possible) and recognise need for change in focus of care and treatment goals at critical decision points in the course of a life-limiting condition. Demonstrates advanced physical examination and diagnostic reasoning skills, analyse data (lab results, x-rays etc) to reach a diagnosis, involving and assisting others appropriately. Demonstrates the ability to conduct complex assessments, and can advise on appropriate assessment tools. Integrates advanced palliative care knowledge and skills to identify the complex and multiple palliative care needs of individuals, their caregivers and family. Has the ability to predict and prevent potential problems, then dealing with them accordingly. Participates in continuous assessment and performance of self and peers. Demonstrate an ability to analyse complex clinical information to inform diagnosis and decision making. Can assess the risk of complicated grief.

17 Recommended technical competencies Interpreting results Assessing and managing symptoms IV and blood Catheterisation Risk assessment Non-pharmacological interventions Palliative care emergencies Pressure area Wounds Teaching

18 From here?

19 Other work to be done. Widely recognised that palliative care is applicable across a range of healthcare settings, from tertiary hospitals to primary care. There are clear elements of palliative care training and core competencies for practice that are relevant to all professional groups involved in palliative care. GENERAL CORE COMPETENCIES FOR PALLIATIVE CARE

20 References Frenk, J, et al. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The lancet, 376(9756), McConigley R, et al (2012). Implementation and evaluation of an education program to guide palliative care for people with motor neurone disease. Palliat Med; 26:

21 Questions??