Visible, Accessible and Integrated Care Capability Framework for the Advanced Practitioner: Nursing in the Community

Transcription

1 Nursing, Midwifery and Allied Health Professionals Visible, Accessible and Integrated Care Capability Framework for the Advanced Practitioner: Nursing in the Community

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3 CONTENTS 1 Introduction 2 2 Developing capability 10 3 Development, structure and use of the capability framework 12 References 22 Appendix 1: NMC definition of the advanced nurse practitioner 24 Appendix 2: Overarching themes of advanced practice 25 Appendix 3: Mapping of the seven core elements of nursing in the community 26 1

4 1 INTRODUCTION Nurses have a strong tradition of providing services in the community. They have many diverse roles and work with a range of population groups in homes, schools and the community, including children, young people, families and older people. In addition, nurses in the community are seen as key people in responding to the complex and changing demands on health and care services. The structure of health services and the definitions of professional roles and boundaries are changing rapidly, with more emphasis on delivering services in the community. To prevent ill health, health services need to focus on health improvement and wellness, rather than just treating illness and disease. There is also a drive to develop community-based services that are proactive, modern, seamless and safe. Changes in current ways of working to improve health and develop services that respond to people s needs are bringing health and social care workers and professionals together from different disciplines and agencies in the public, voluntary and private sector (SEHD, 2006a; SEHD, 2006b; SEHD, 2006c). Three increasingly prominent factors are facing health professionals as they plan future services in the community: people living longer; persistent health inequalities; and a rising rate of long-term conditions. These factors are changing the nature of demands on health and care services in the community mainly because they lead to multiple and age-related conditions. These in turn result in more complex and multiple needs, hospital re-admissions and emergency admissions (SEHD, 2005; SEHD, 2007a). We must also focus services on children and young people to address the needs of those who may be vulnerable or at risk from an early age (SEHD, 2007a; SEHD, 2007b; SG, 2008). 2

5 Introduction to the framework This capability framework is aimed at nurses working in or towards an advanced practitioner role in community health nursing teams, as shown in the proposed new service model for nursing in the community (figure 1). The advanced practitioner: nursing in the community is a unique new clinical role in Scotland. Individuals, carers, families and communities Maternity Services Acute sector Community nurse consultant Independent sector care providers Community hospitals Team Leader Advanced Practitioner Occupational health service providers Local authority teams Community Health Nurse (CHN) Primary healthcare team including practice nurses, community pharmacicts etc. Children s and young people s services Community staff nurse Mental health and learning disability teams Health care support worker Administrative support Individuals, carers, families and communities Figure 1: New service model for nursing in the community (SEHD, 2006a; p16) 3

6 This framework builds on the capabilities, practice learning achievements and key content in the capability framework for community health nursing (NES, 2007a). It outlines the focus, level of practice and generic knowledge, skills and approaches needed by the advanced practitioner: nursing in the community. It is expected that nurses using this framework will have competence and capability as a community practitioner that equates to the senior level of practice in the careers development framework (figure 2). This competence and capability will have arisen from, for example, achievement of a specialist practice qualification and experience in community nursing or specialist community public health nursing; or through transitional education for community health nursing. Figure 2: Levels of practice for roles in the core community health nursing team Advanced practitioner: nursing in the community Community health nurse Advanced practitioner level Senior practitioner level Community staff nurse Core nursing roles within the service model (SEHD, 2006a) Core practitioner level Careers development framework (Skills for Health, 2006) 4

7 Role of the advanced practitioner: nursing in the community Within the proposed service model for nursing in the community (figure 1), the advanced practitioner will work as part of and across community health nursing, multi-disciplinary and multi-agency teams in community health partnerships. It is envisaged that advanced practitioners will provide enhanced co-ordination of care for people with a high degree of complexity of need (SEHD, 2006a). Advanced practitioners will apply their breadth of advanced level knowledge and skills, as well as their expertise in a specific field of practice (RCN, 2008), to deal with a high degree of complexity of need and vulnerability, and provide clinical leadership. This new role s value will be enhanced by being proactive in identifying individuals, families and communities with highly complex needs; preventing and detecting vulnerability; promoting health and wellbeing; responding to existing or potential ill-health issues and reducing unplanned hospital admissions (SGHD, 2008). Advanced practitioners will work within the seven core elements of nursing in the community (SEHD, 2006a; SGHD, 2008) to: provide expert clinical case management to individuals, families, carers and communities in a defined population undertake advanced level assessment to address highly complex health needs of individuals, families, carers and communities by using expert knowledge and clinical judgement to diagnose, intervene and refer appropriately provide clinical leadership at strategic and practice levels, using evidence-based practice to promote effective health outcomes provide a high level of risk management provide leadership for, and deliver, effective and efficient services that correspond to predetermined clinical performance targets 5

8 Advanced practice In recent years, the concept of advanced and specialist nursing practice has been much debated in national and international literature. Specialisation may be one element of advanced practice, but defining it only by that limits its scope (Mantzoukas and Watkinson, 2006; RCN, 2008). In addition, the suggestion that all roles above initial practice level, including specialist and consultant roles, are advanced practice is simplistic; confusing for the public and professionals; lacks clarity or consistency; and affects governance due to expectations created by practitioners, public and the service (Sabin, 2008). It may be more helpful to view advanced practice as a particular stage on a developmental continuum between novice and expert practice (figure 3). The advanced role will have high levels of clinical skills, competence and autonomous decision-making. Specialist practice can then be viewed as one end of a specialist generalist continuum (figure 3), with specialist practice being particular to a specific context such as, for example, a client group, a skill set or an organisational context (Sabin, 2008). Figure 3: Framework of advanced and specialist practice (Sabin, 2008; p12) Expert Practice Advanced Generalist Specialist Practice Generalist Practice Junior Specialist Novice Practice 6

9 The NHS Career Framework (Skills for Health, 2006) provides definitions of nine benchmark levels of roles across professional groups. The definition of advanced practitioner at level 7 in the Career Framework is being seen as overarching for advanced practice across professional groups and across practice contexts such as education, clinical practice and management (Sabin, 2008). The definition is: Experienced clinical professionals who have developed their skills and theoretical knowledge to a very high standard. They are empowered to make high level clinical decisions and will often have their own caseload. Non clinical staff at level 7 will typically manage a number of service areas. (Skills for Health, 2006) In addition, the Nursing and Midwifery Council 1 (NMC, 2005a) defines advanced nurse practitioner as: Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat health care needs and refer to an appropriate specialist if needed. Approval for the regulation of clinical advanced nurse practitioners by the Nursing and Midwifery Council has been delayed because of the implications of the White Paper Trust, Assurance and Safety (DH, 2007) on the regulation of health professionals for the 21st century. Key drivers for an advanced level of nursing practice should be clientcentredness and improving health outcomes for individuals, families and communities (NES, 2007b). Four overarching advanced practice themes, drawn from national and international literature, have been identified in work by NHS Education for Scotland in developing and piloting a development pathway for advanced practice succession planning (NES, 2007c). The four themes are of equal importance and comprise the main components of advanced practice. These themes 2 are: leadership facilitating learning research advanced clinical practice These four themes, along with the competencies for advanced nurse practitioners (NMC, 2005b) have informed the development of practice learning achievements in this capability framework. Figure 4 illustrates the relationship between the themes and the development of advanced practice in relation to differing levels of complexity of health needs in the community. 1 The full definition is reproduced at Appendix 1 2 See appendix 2 for full description 7

10 Figure 4: Advanced practice themes and development (adapted from NES, 2008) Facilitating learning Leadership Advanced clinical practice Research CONSULTATION AND FACILITATION TO IMPROVE PRACTICE VALUES-BASED CARE AUTONOMY AND RESPONSIBILITY High degree of complexity of need, and vulnerability; co-morbidity. Case management. Anticipatory care. More complex needs and vulnerability. Disease management. Care management. Anticipatory care. Uncomplicated needs. Supported self care. Core level care and intervention. Health promotion. CLINICAL DECISION-MAKING COMPLEXITY AND VULNERABILITY CRITICAL THINKING AND ANALYTICAL SKILLS 8

11 The advanced practice themes are underpinned by a number of key principles that all nurses working at an advanced level of practice should develop and demonstrate (NES, 2007c). These principles are: autonomous practice involves the freedom to exercise judgement about actions, in turn accepting responsibility for them, and being held to account. critical thinking practising autonomously requires higher-level critical thinking skills. Critical thinking allows advanced practitioners to explore and analyse evidence, cases and situations in clinical practice, enabling a high level of judgement and decision-making. high levels of decision-making and problem solving an advanced practitioner would be expected to demonstrate expertise in complex decision-making in relation to their role, including determining what to include in the decision-making process and making a decision based on judgement and critical thinking. values-based care 3 advanced practitioners would be required to have a high level of awareness of their own values and beliefs. Care is negotiated with service users, carers and families as equal partners. improving practice it is important that advanced practitioners deliver advanced practice that is evidence based while acting as positive role models who enable change and practice improvement. 3 Values-based care is about working in a positive and constructive way with difference and diversity. It is about putting the values, views and understanding of individuals, families and communities at the centre of everything we do (NES, 2007d) 9

12 2 DEVELOPING CAPABILITY This framework is underpinned by the idea of capability, which goes beyond the idea of competence. It has been informed by and adapted from previous work by the Sainsbury Centre for Mental Health (SCMH) (2001), the Department of Health (2004a), and the Combined Sheffield Universities Interprofessional Learning Unit (2004). Capability is associated with helping practitioners to continue developing their abilities and potential. It is an essential element of lifelong learning, and personal and professional development. Capability is based on the theory of how adults learn and develop, and includes the notion of complexity (Price, 2004; Fraser and Greenhalgh, 2001). It has been defined by Stephenson (1998; p2) as: an integration of knowledge, skills, personal qualities and understanding used appropriately and effectively not just in familiar and highly focused specialist contexts but in response to new and changing circumstances. Capability differs from competence, in that competence describes what individuals know or are able to do in terms of knowledge, skills and attitudes at a particular point in time (Fraser and Greenhalgh, 2001; Stephenson, 1998). It has been argued that competencies do not take into account complexity (Wilson and Holt, 2001) and that practitioners need more than a prescribed set of competencies to carry out their roles effectively (SCMH, 2001). Capability therefore includes gaining competence in carrying out the current job and the ability to develop further competence to meet future demands (Stephenson, 1998). Capability describes how far an individual can apply, adapt and combine new knowledge from experience and continue to improve their performance (Fraser and Greenhalgh, 2001). It also involves having confidence in one s ability and a commitment to learn from experience (Stephenson, 1998). The ability to adapt to frequent change involves professional judgement, decisionmaking skills and knowledge gained from experience in many different (but similar) situations. The more expert the practitioner, the more likely they are to adapt in unpredictable and unfamiliar circumstances (Benner, 1984). Capability frameworks focus on: realising an individual s full potential developing the ability to adapt and apply knowledge and skills learning from experience envisaging the future and helping to make it happen 10

13 These elements are part of continuing professional development, lifelong learning and personal development goals, each of which is vital to current and future healthcare practitioners. A capability approach to learning incorporates flexibility to respond to the specific, self-identified learning needs of practitioners (Gardner et al, 2006). A capability approach fits well with the NHS Knowledge and Skills Framework (NHS KSF) (DH, 2004b), the overarching framework for reviewing the development of most staff groups in the NHS, as part of the Agenda for Change agreement. The NHS KSF defines and describes the knowledge and skills staff need to apply to deliver quality services (DH, 2004b) and the review process is the means for providing evidence of continuing capability. A capability framework is a broad outline of what practitioners should be able to do in practice. Capability frameworks are usually supported by disciplinespecific competency frameworks detailing the level of expertise required. This framework incorporates practice learning achievements to detail what the advanced practitioner: nursing in the community should be able to achieve, and to capture the idea of capability as current competence combined with the development of future potential competence. Capabilities include several components (SCMH, 2001; p2): a performance component identifies what skills individuals need to possess and what they need to achieve in the workplace an ethical component concerned with integrating knowledge of culture, values and social awareness into professional practice a component that emphasises reflective practice in action the capability to effectively implement evidence-based interventions in the changing context of health services a commitment to working with new models of professional practice and accepting responsibility for lifelong learning. 11

14 3 DEVELOPMENT, STRUCTURE AND USE OF THE CAPABILITY FRAMEWORK Developing the capability framework This capability framework is being developed as one part of the educational work that NHS Education for Scotland is leading on for the national project to test and evaluate the new service model as outlined in figure 1. The educational work is one of the three overarching aspects of work to support the national project, the other two being workforce and workload planning, and evaluation. This framework has been developed from the capabilities, practice learning achievements and key content in the capability framework for community health nursing (NES, 2007a). It was developed with nurses working in various roles at different levels in the community and the health service. A working group was convened to help define the scope, focus and required knowledge and skills for the advanced practitioner: nursing in the community within an initial draft framework. This group included nursing expertise within advanced practice, district nursing, long-term conditions, older people, public health nursing, school nursing and child protection. A second draft of the framework was developed, and wide consultation occurred across Scotland with relevant stakeholders. Small group meetings were held with practitioners in three of the four health board sites involved in testing the service model. Workshops were also held at an event organised by the Scottish Government for lead nurses and team leaders from the sites involved in the national project. Discussion in the workshops focused on the intended purpose, remit and focus for the advanced practitioner: nursing in the community in local areas. Further information from the consultation on this capability framework can be found at Structure of the capability framework This framework is presented under the same four areas that were used to structure the capability framework for community health nursing (NES, 2007a): Practising ethically this makes assumptions about the values and attitudes needed to practise with individuals, families, carers and communities who have highly complex needs and who face inequality in health outcomes. Knowledge for practice is the foundation for effective practice. The capability of an advanced practitioner involves the ability to apply a broad base of advanced level knowledge and skills, which builds on expertise in their field of practice (RCN, 2008). Leadership for practice describes the capabilities of the advanced practitioner: nursing in the community for effective clinical leadership at strategic and practice levels across community health nursing, multi-disciplinary and multi-agency teams. Co-ordinating and delivering care and intervention are the capabilities specific to the advanced practitioner: nursing in the community who is applying a high level of clinical skills, competence and autonomous decision-making to evidence-based approaches, care and intervention. The draft framework was examined and amended after analysing responses from the consultation, meetings and workshops. The process of developing this capability framework has been shared with a steering group for the educational work that NHS Education for Scotland is leading on for the national project. 12

15 Each area contains: capabilities broad statements of intent practice learning achievements detailing the generic knowledge, skills, attitudes and behaviours that the advanced practitioner: nursing in the community should be capable of demonstrating in practice key content depicting an outline knowledge base required to achieve practice learning achievements The capability framework also indicates links between the practice learning achievements and areas of the NHS KSF (DH, 2004b). These links were identified in partnership with the lead person for implementing the NHS KSF from the workforce modernisation division of NHS Scotland. The seven core elements of nursing in the community (SEHD, 2006a) have been mapped with the practice learning achievements, as shown in appendix 3, as they are seen to underpin the activity of nurses in the community. The mapping is based on the descriptions of each of the core elements presented in Visible, Accessible and Integrated Care (SEHD, 2006a; p17) Use of the capability framework This capability framework will be used in the four health board areas currently involved in testing and evaluating the new service model as outlined in figure 1 to identify education and work-based learning needs for the role of advanced practitioner: nursing in the community. The focus of the role will be set locally and in response to identified health needs in community health partnerships. Some suggested examples of its focus across different parts of Scotland are available at This capability framework could be used in a number of ways, for example: to identify individual professional development and learning needs to meet the capability required for advanced practitioner: nursing in the community to identify advanced-level skills and roles required to meet the identified health needs in community health partnerships to plan and develop education curriculum and provision as a guide to ensure that nurses working at or towards an advanced level are aspiring to the same goals, and to promote lifelong learning It is expected that those using the framework for professional development will be supported and guided by an experienced mentor. Practitioners wishing to identify their learning development needs for advanced-level practice may wish to use the needs analysis tool for advanced practice development along with their professional development plan. The tool is being used as part of the advanced practice succession planning pathway pilot that is being run by NHS Education for Scotland (NES, 2007c), and is available at When using this framework, practitioners will also find it useful to refer to the capabilities, practice learning achievements and key content in the capability framework for community health nursing, (NES, 2007a), which is available at: 13

16 Domain Capability 1. Practising ethically 1.1 Continually extends and uses detailed knowledge of culture, diversity and professional, legal and ethical frameworks to identify and address complex health and care needs of people in the community in an inclusive, safe and non-discriminatory way. Practice learning achievements Indicative KSF link Key content Establishes ways for marginalised and vulnerable individuals, families, carers and communities to use and influence services, information and skills Actively promotes an understanding at practice and strategic level of the effects of inequality and cultural differences and how to address them Advocates for health and wellbeing and reducing inequalities in health, within practice, policy and research Proactively works to identify and address beliefs, values and practice that could cause harm or violate the human rights or safety of people Leads and carries out equality and health impact assessments when developing new services, policies and protocols Actively engages individuals, families and communities in the development and dissemination of education information resources, research and evaluation to meet people s needs Enables others across teams to understand complex ethical issues and comply with differing legislative requirements related to defined population groups Applies ethical principles in the design of research, evaluation, audit and dissemination of evidence-based practice and knowledge. C6, HWB1 C4, C5, HWB1 C4, HWB1 C6 C4, HWB1 HWB1 C5, HWB3 NMC code of professional conduct Understanding of power relationships between service users, communities and professionals Community-focused and clientcentred approaches Human rights, including rights of children and young people, carers and other vulnerable groups Social justice Targeted service provision Understanding of impact of inequality upon health Empowerment and participation of individuals, families, carers and communities Advocacy Advanced communication skills C5 Complex ethical, legal and professional issues Culture, equality and diversity issues 14

17 Domain Capability 2. Knowledge for practice 2.1 Continually extends and applies detailed knowledge of the legislation and policy that form the current framework in which the health and care needs of people in the community are addressed. Practice learning achievements Indicative KSF link Key content Influences the development of strategies for the implementation and monitoring of new legislation, guidelines, policy and procedures at local level Influences development and implementation of local and regional policy, highlighting contemporary evidence Influences the development of and uses effective strategies and systems to ensure effective sharing of information with client groups and across disciplines and agencies. C5, HWB3 C4, C5 C4, C5 Broad scope of legislation, policies, procedures and guidelines related to health, wellbeing and protection of defined populations Corporate policies on equality and diversity Evidence-based practice Understanding of ideology, interests and concept of power in policy development and implementation Political astuteness in a multidisciplinary and multi-agency context 15

18 Domain Capability 2. Knowledge for practice 2.2 Continually extends own and promotes an understanding of resources, services and networks among people in the community, agencies and sectors to influence the delivery of care, interventions and partnership working. Practice learning achievements Indicative KSF link Key content Applies extensive, detailed knowledge to build and maintain a therapeutic team in response to identified needs in the promotion of optimum health outcomes Applies expert networking skills and a strategic overview across organisational and geographical boundaries to promote seamless provision of care and public health improvement Applies advanced communication skills to promote positive working relationships with individuals, families, carers, communities, peers and senior colleagues for effective partnership working. HWB1 HWB1 C1, HWB1 Knowledge of different roles, services and referral pathways within specialist services and across primary, secondary and tertiary services; health and social care sectors; statutory, voluntary and private sectors Public health and community resources, services and networks Application of knowledge to ensure effective partnership, multi-agency and multi-disciplinary team working Expert networking skills Influencing and negotiation skills Community-focused and clientcentred approaches Involvement and empowerment of individuals, families, carers and communities 16

19 Domain Capability 2. Knowledge for practice 2.3 Continually extends and applies detailed knowledge and evaluates complex theories, perspectives and research in making clinical judgements and decisions to identify and address the health and care needs of people in the community. Practice learning achievements Indicative KSF link Key content Applies critical thinking and reasoning in clinical decision-making and problem-solving to assess, manage and evaluate complex situations Applies principles of epidemiology and demography to identify at-risk populations, patterns of disease and effectiveness of prevention and interventions Evaluates the health and social impact of dynamics between community, public health issues, vulnerability and inequality on the health of individuals, families, carers and communities Applies detailed and extensive knowledge of theoretical frameworks, evidence and research findings to help build an evidence base around the needs of defined population groups Undertakes and contributes to the design, conduct and dissemination of research, evaluation and audit that responds to gaps in evidence base. HWB2 HWB2, (IK2) 4 HWB1, HWB2 HWB1, C5 C5 Philosophy and practice of nursing theory, models and concepts Case finding Autonomous professional practice Multiple intelligences and appreciative enquiry Research, evaluation and audit design and techniques Participatory appraisal techniques Qualitative and quantitative methods and sources of data for interpretation and measurement of health needs and outcomes Critical appraisal of research and evaluation data Clinical reasoning Evidence-based practice Equality, diversity and culture 4 Information and knowledge dimensions tend to relate to ancillary and clerical positions. The need for interpretation and analysis of data at an advanced level of nursing practice could, therefore, be incorporated in core dimension HWB2 17

20 Domain Capability 3. Leadership for practice 3.1 Continually seeks ways to involve people in the community in the collaborative development of high-quality, sustainable community health nursing services, health care services and public health improvement programmes across geographical and organisational boundaries that meet the health and care needs of people in the community. Practice learning achievements Indicative KSF link Key content Provides innovative and creative solutions that challenge service provision and traditional boundaries Develops strategies that enable people in the community to contribute to joint planning and development of services and public health improvement programmes in partnership with professionals Contributes to the strategic development of community health nursing services, public health improvement programmes and health care provision in the community across organisational and geographical boundaries Critically appraises evidence to develop and support a business case for service development, redesign and public health improvement programmes Leads initiatives to gain commitment and sustainable funding for projects and services designed to improve health outcomes for individuals, families, carers and communities. C4 C4, HWB1 C4, HWB1 C4, HWB1 C1, HWB1 Influencing and negotiation skills Effective local and professional networks Consultancy role; entrepreneurial skills Strategic thinking Community planning structures Involvement and participation of individuals, families, carers and communities in planning Knowledge of sources of funding and resources Robust evidence base to support arguments Demonstrable skills in leadership; project management; and service development Supporting and developing creative and innovative thinking Highly developed report writing and presentations 18

21 Domain Capability 3. Leadership for practice 3.2 Continually provides clinical leadership and expert, evidence based knowledge across community health nursing teams and the wider multi-disciplinary, multi-agency context to promote optimum health outcomes for people in the community. Practice learning achievements Indicative KSF link Key content Strategically assesses limitations of knowledge and skills relating to health needs of defined populations while working collaboratively to promote professional development Critically appraises and synthesises evidence from a range of sources, enabling teams to use evidence in practice to promote optimum health outcomes Facilitates team learning from significant-event analysis and root-cause analysis and develops, implements and evaluates action plans to support learning Supports community health nursing teams to encompass different ways of responding to identified health and care needs of people in the community Uses expert knowledge, clinical judgement and decision-making skills to advise, manage and offer support across teams in complex situations Acts as a role model for promoting personal and professional development and lifelong learning. C2, C5 Education and training Clinical supervision Case supervision Adult learning styles C2, C5 Local and national strategies for professional development of practice C2, C5 Understanding of role of emotions in learning Critical reflection on practice C2, C5 Significant event analysis Root-cause analysis C2, C5 Evidence-based practice C2 19

22 Domain Capability 4. Coordinating and delivering care and intervention 4.1 Continually uses expert knowledge, clinical judgement and evidence across community health nursing, multi-disciplinary and multiagency teams to prioritise, lead on and manage community-focused, client-centred care and intervention for people in the community with complex health and care needs. Practice learning achievements Indicative KSF link Key content Strategically and proactively appraises data to identify population groups and individuals at most risk of vulnerability and deterioration in their health Works in partnership with individuals, families and carers to continually assess, coordinate and evaluate plans to address their complex health and care needs Demonstrates a substantial level of autonomy and clinical decision-making regarding nursing assessment, interventions, referral and service provision in highly complex situations Leads on the establishment of and uses direct referral pathways in meeting the identified complex health and care needs of defined populations Appraises and meets professional development requirements to extend clinical competence, knowledge and skills for advanced level practice required to address identified health needs within local area. HWB1, (IK2) 5 HWB1, HWB2, HWB4, HWB5 HWB1, HWB2, HWB5 HWB2, HWB Acts as a role model in ethically managing and using own and others resources. C2, HWB2 C2 NMC code of professional conduct Autonomous professional practice Assessing and managing risk; highly complex health and care needs; co-morbidity; vulnerability Case finding and case management Advanced level physical and psychosocial assessment Inter-agency assessment tools and approaches Anticipatory care Health behaviour change Building social capital Independent prescribing Clinical reasoning Advanced level clinical decisionmaking and problem-solving skills Direct referral pathways High level of clinical skills Advanced communication skills Evidence-based practice Medico-legal issues NMC draft competencies for advanced nurse practitioner roles Understanding of advanced practice Community-focused and clientcentred approaches 20 5 Information and knowledge dimensions tend to relate to ancillary and clerical positions. The need for interpretation and analysis of data at an advanced level of nursing practice could, therefore, be incorporated in core dimension HWB1.

23 Domain Capability 4. Coordinating and delivering care and intervention 4.2 Continually uses expert knowledge, clinical judgement and appropriate evidence across community health nursing, multi-disciplinary and multi-agency teams to assure, evaluate and develop the quality of care and intervention for defined populations. Practice learning achievements Indicative KSF link Key content Undertakes strategic risk assessments that have a credible assessment process and coordinates risk management plans that will protect the public and staff Develops and evaluates management protocols that cover pathways of care and interventions across organisational and geographical boundaries Disseminates, monitors and promotes the use of research, evaluation and audit findings for evidence-based care and intervention Establishes data collection methods and works collaboratively to agree and measure quality indicators Leads and initiates the audit cycle and works collaboratively to act on findings to enhance care and intervention for people Promotes use of clinical supervision and reflective practice to support the quality of nursing care and intervention Establishes and uses effective processes for sharing and documenting information across teams in a multi-disciplinary and multi-agency context. C3, HWB3 Understanding risk theory Individual and organisational risk C5, HWB5 Appraisal of best evidence and best practice Recognition of poor practice C5 and challenging practice Equitable access, enhanced quality and C5, (IK2) 6 C5 C2, C5 C1, C5 efficiency of care and interventions Organisational policies and guidelines on record keeping; documentation; data protection and use of information technology Codes of practice for sharing information when a person is at risk of harm Clinical governance and quality improvement frameworks Evidence-based guidelines, protocols and standards Quality indicators Clinical and case supervision 6 Information and knowledge dimensions tend to relate to ancillary and clerical positions. The need for interpretation and analysis of data at an advanced level of nursing practice could, therefore, be incorporated in core dimension C5. 21

24 REFERENCES Benner PA (1984) From Novice to Expert: Excellence and power in clinical nursing practice. Menlo Park, California: Addison Wesley. Combined Universities Interprofessional Learning Unit (2004) Interprofessional capability framework. Sheffield: The University of Sheffield and Sheffield Hallam University. Department of Health (2004a) The Ten Essential Shared Capabilities: A framework for the whole of the mental health workforce. London: DH. Department of Health (2004b) The NHS knowledge and skills framework (NHS KSF) and the development review process. London: DH. Department of Health (2007) Trust, Assurance and Safety the Regulation of Health Professionals in the 21st Century. London: DH. Fraser SW, Greenhalgh T (2001) Coping with complexity: educating for capability. British Medical Journal 323: Gardner G, Dunn S, Carryer J and Gardner A (2006) Competency and capability: imperative for the nurse practitioner education. Australian Journal of Advanced Nursing 24, 1: Mantzoukas S and Watkinson S (2006) Review of advanced nursing practice: the international literature and developing the generic features. Journal of Clinical Nursing 16, NHS Education for Scotland (2007a) Visible, Accessible and Integrated Care Capability Framework for Community Health Nursing. Edinburgh: NES. Available from Accessed 2 July NHS Education for Scotland (2007b) Modernising Nursing Careers Scottish Projects: Advanced Practice and Early Clinical Career Fellowships. Report of three related events in Elgin; Glasgow and Edinburgh. Edinburgh: NES/Scottish Government. NHS Education for Scotland (2007c) Pilot Consultation on the pilot Succession Development Pathway (Post Consultation) Edinburgh: NES. Available from: Accessed 2 July NHS Education for Scotland (2007d) The 10 shared essential capabilities for mental health learning materials. Edinburgh: NES. NHS Education for Scotland (2008) Working with individuals with cancer, their families and carers. Professional development framework for nurses, specialist and advanced level. Edinburgh: NES. Nursing and Midwifery Council (2005a) Implementation of a Framework for the Standard for Post Registration Nursing Decision. Agendum 27.1 December 2005/c/05/160. London: NMC. Available from aframedisplay.aspx?documentid=1669. Accessed 2 July Nursing and Midwifery Council (2005b) Mapping of the NMC approved competencies against the KSF. Annex 1 to C/05/160. London: NMC. Available from Accessed 2 July Price J (2004) Educating the healthcare professional for capability. In: Kernick D (ed.) Complexity and Healthcare Organization: A View from the Street. Oxford: Radcliffe (p ). Royal College of Nursing (2008) Advanced nurse practitioners an RCN guide to the advanced nurse practitioner role, competencies and programme accreditation. London: RCN. Sabin M (2008) Supporting the Development of Advanced Practice A Toolkit Approach. Edinburgh: Scottish Government Chief Nursing Officer Directorate. Sainsbury Centre for Mental Health (2001) The Capable Practitioner. London: SCMH. 22

25 Scottish Executive Health Department (2005) Building a Health Service Fit for the Future. Edinburgh: SEHD. Scottish Executive Health Department (2006a) Visible, Accessible and Integrated Care. Report of the review of nursing in the community in Scotland. Edinburgh: SEHD. Stephenson J (1998) The concept of capability and its importance for higher education. In: Stephenson J, Yorke M (Eds.) Capability and Quality in Higher Education. London: Kogan Page (p 1-13). Wilson T, Holt T (2001) Complexity and clinical care. British Medical Journal 323: Scottish Executive Health Department (2006b) Delivering Care, Enabling Health: Harnessing the nursing, midwifery and allied health professions contribution to implementing Delivering for Health in Scotland. Edinburgh: SEHD. Scottish Executive Health Department (2006c) Delivering a Healthy Scotland Meeting the Challenge: Health Improvement in Scotland Annual report. Edinburgh: SEHD. Scottish Executive Health Department (2007a) Better Health, Better Care: Action Plan. Edinburgh: SEHD. Scottish Executive Health Department (2007b) Delivering a Healthy Future. An action framework for children and young people s health in Scotland. Edinburgh: SEHD. Scottish Government Health Department (2008) Advanced practitioner [Nursing in the Community] job description. Draft, June. Available from JobDescriptions/AdvancePractitioner. Accessed 2 July Scottish Government (2008) Equally Well. Report of the ministerial task force on health inequalities. Edinburgh: SG. Skills for Health (2006) Career Framework for Health. Available at Accessed 2 July

26 APPENDIX 1 Full definition of advanced nurse practitioner role (NMC, 2005a) Advanced nurse practitioners are highly experienced and educated members of the care team who are able to diagnose and treat health care needs and refer to an appropriate specialist if needed. Advanced nurse practitioners are highly skilled nurses who can: take a comprehensive patient history carry out physical examinations use their expert knowledge and clinical judgment to identify the potential diagnosis refer patients for investigations where appropriate make a final diagnosis decide on and carry out treatment, including the prescribing of medicines, or refer patients to an appropriate specialist use their extensive practice experience to plan and provide skilled and competent care to meet patients health and social care needs, involving other members of the health care team as appropriate ensure the provision of continuity of care including follow-up visits assess and evaluate, with patients, the effectiveness of the treatment and care provided and make changes as needed work independently, although often as part of a health care team provide leadership; and make sure that each patient s treatment and care is based on best practice 24

27 APPENDIX 2 Overarching themes of advanced practice (NES, 2007c) Leadership Facilitating Learning Research Advanced clinical practice Identifying the need for change, leading innovation and managing change, including service development Developing case for change Negotiation and influencing skills Networking Principles of teaching and learning Supporting others to develop skills and knowledge Promotion of learning/creation of learning environment Patient teaching and information giving Developing patient education materials Advanced values-based knowledge Ability to access research/use information systems Critical appraisal/evaluation skills Involvement in research/audit Ability to implement research findings into practice, including development of policies, protocols and guidelines Conference presentations Publications Decision making/clinical judgment and problem solving Critical thinking and analytical skills incorporating critical reflection Managing complexity Clinical governance Equality and diversity Ethical decision making Assessment, diagnosis, referral and discharge Achievement of NMC draft competencies Developing higher levels of autonomy Assessing and managing risk Prescribing Developing confidence Developing therapeutic nursing to improve patient outcomes Higher-level communication skills Patient focus/public involvement 25

28 APPENDIX 3 Mapping of the seven core elements of nursing in the community Seven core elements of nursing in the community (SEHD, 2006a) Working directly with individuals and their carers Practice Learning Achievements 1.1.1; 1.1.6; 2.1.1; 2.1.3; 2.2.1; 2.2.3; 2.3.1; 2.3.2; 2.3.3; 2.3.4; 2.3.5; 3.1.2; 3.2.1; 3.2.2; 3.2.3; 3.2.4; 3.2.5; 4.1.1; 4.1.2; 4.1.3; 4.1.4; 4.1.5; 4.2.1; 4.2.2; 4.2.3; 4.2.4; 4.2.5; Adopting public health approaches to protecting the public 2.1.1; 2.1.3; 2.2.1; 2.2.3; 2.3.1; 2.3.2; 2.3.3; 2.3.4; 2.3.5; 3.1.2; 3.2.3; 3.2.4; 3.2.5; 4.1.1; 4.1.2; 4.1.3; 4.1.4; 4.1.5; 4.2.1; 4.2.5; Co-ordinating services 2.2.1; 2.2.2; 2.3.1; 2.3.2; 3.1.3; 3.2.5; 4.1.2; 4.1.4; Supporting self care 2.3.1; 2.3.3; 2.3.4; 2.3.5; 3.2.4; 4.1.2; 4.1.3; 4.1.5; 4.2.5; Multi-disciplinary and multi-agency team working 1.1.4; 1.1.5; 1.1.7; 2.1.3; 2.2.1; 2.2.2; 2.2.3; 3.1.1; 3.1.2; 3.1.3; 3.1.5; 3.2.1; 3.2.2; 3.2.3; 3.2.4; 3.2.5; 4.1.4; Meeting health needs of the community 1.1.1; 1.1.2; 1.1.3; 1.1.4; 1.1.5; 1.1.6; 1.1.7; 1.1.8; 2.1.1; 2.2.2; 2.2.3; 3.1.1; 3.1.2; 3.1.4; 3.1.5; 3.2.4; Supporting anticipatory care 1.1.3; 2.3.1; 2.3.2; 2.3.5; 3.2.4; 4.1.1; 4.1.5; 4.2.5;

29 NOTES 27

30 28 NOTES

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