Influencing and Improving Respiratory Care in Scotland

Transcription

1 Influencing and Improving Respiratory Care in Scotland Career and Development Framework for Nurses Providing Respiratory Care in Scotland The values, skills, and knowledge needed to deliver high quality care in a full range of settings.

2 This Framework is based on the Career and Development Framework for Nursing in Occupational Health developed by NHS National Education Scotland (NHS NES, 2011). It has been adapted to reflect Respiratory services and needs. Developed on behalf of the SRNF by Liz Anderson Practice Development Nurse-Respiratory NHS Ayrshire & Arran Olwyn Lamont Lead Respiratory Nurse NHS Forth Valley Acknowledgements The Scottish Respiratory Nurse Forum would like to sincerely thank representatives from across Scotland who contributed to the adaptation of this Framework. 2

3 Contents Introduction Page Background 4 Why develop this framework? 4 Who is the framework for? 5 How should the framework be used? 5 Framework Overview The structure of the framework 6 Respiratory Skills 7 Primary Care Nurse Quick Guide 8 Acute Care Nurse Quick Guide 9 Respiratory Specialist Nurse Quick Guide 10 The Framework Practitioner Level Senior Level Advanced Practitioner Level Consultant Practitioner Level Senior Practitioner Level Skills Guide Supporting Implementation 49 Appendix One 50 3

4 Introduction Background The Career Framework for Health outlines the level of knowledge, competence, responsibility, and associated experience, required for the delivery of roles within NHS Scotland. It has been designed to support NHS Boards with workforce planning and service redesign and to help individual members of staff, with transferable, competencebased skills to progress in a direction that meets workforce, service and individual needs. It does this by mapping the entire NHS Scotland workforce into a nine level core skills (appendix 1, page 50) and competences framework. The nine levels represent a clustering of roles which are grouped according to complexity, responsibility and the level of experience and knowledge needed to carry them out (Scottish Government, 2009). Why develop this framework? In Scotland, there is an increasing policy focus on long-term conditions which advocate shifting the balance of care from hospital to community through the development and delivery of services that are person-centred and proactive (Audit Scotland, 2007; The Scottish Government, 2007; The Scottish Executive, 2005). NHS Quality Improvement Scotland (NHS QIS) has produced clinical standards aimed at promoting quality assurance of Asthma and COPD services. Education and training of healthcare professionals is key to the delivery of these standards (NHS QIS, 2010 and 2007). This document aims to support the implementation of National and Respiratory policy by detailing the knowledge and skills that nurses working in various settings/roles should possess. Supporting them to deliver a high standard of care that is safe, evidence-based and equitable. 4

5 Who is the framework for? The framework maps the knowledge and skills that general and specialist nurses should possess when practicing Respiratory care in different settings. This framework applies to Respiratory care only. Some generalist nurses may be advanced practitioners in other fields. Nurses should not be limited by this framework and should be encouraged to progress through the framework if relevant to their role or future development. Personal Development and Succession planning should be encouraged. How should the framework be used? For nurses and service managers: to guide personal development planning by highlighting the support and development needed to promote effective working, and career progression, which maps with the NHS Knowledge and Skills Framework. For service users and their families/carers: to explain the key skills, knowledge and attitudes that they should expect from nurses practicing Respiratory care. For education and training organisations: to guide the development of training and educational activities and programmes specific to Respiratory care. 5

6 Framework Overview The structure of the framework Levels 5-9 are applicable to registered practitioners. Practitioner Level 5: Registered practitioners consolidating pre-registration experience and getting ready for a higher level of functioning. Senior Practitioners Level 6: A higher degree of autonomy and responsibility than level 5 in the clinical environment. Advanced Practitioner Level 7: Experienced clinical practitioners with high level of skill and theoretical knowledge. Will make high level clinical decisions and manage own workload. Consultant Practitioner Level 8: Staff working at a very high level of clinical expertise and/or have responsibility for planning services. Senior Practitioner Level 9: Staff with ultimate responsibility for decision-making and full on-call accountability. Four central themes underpin each level. Levels Clinical Practice (including skills) Facilitation of Learning Research and Development Leadership 6

7 Respiratory Skills There are some core skills that are integral to respiratory nursing. The skills guide includes essential elements that should be included in procedures/policies and assessments. Nurses should comply with local procedures/policies at all times. 7

8 These tables provide a guide to the minimum framework level nurses in different settings should aim to possess. Primary Care Nurses Responsibility/Role Roles Framework Level (minimum) Asthma/COPD chronic Practice Nurse 5 disorders management post (pages 11-15) diagnosis in primary care. Respiratory Example Qualifications Skills 1, 3, 4 Essential: Local NHS approved training (should this be SRNF elearning when available) Asthma/COPD diagnosis & chronic disorders management in primary care. Practice Nurse 6 (pages 16-20) Desirable: Respiratory Assessment graduate diploma module Asthma graduate diploma module COPD graduate diploma module 1, 2, 3, 4 Essential: Respiratory Assessment graduate diploma module Asthma graduate diploma module COPD graduate diploma module Respiratory reviews of patients with stable respiratory disorders in the community Respiratory reviews of patients with complex respiratory disorders in the community Community Nurse Community Nurse 5 (pages 11-15) 6 (pages 16-20) Desirable: Graduate certificate or degree in respiratory disorders 1,3,4, 5 Essential: Local NHS approved training Desirable: Respiratory Assessment graduate diploma module COPD graduate diploma module Respiratory Failure graduate diploma module 1, 3, 4, 5, 7 Essential: Respiratory Assessment graduate diploma module COPD graduate diploma module Respiratory Failure graduate diploma module Desirable: Graduate certificate or degree in respiratory disorders 8

9 Acute Care Nurses Responsibility/Role Roles Framework Level (minimum) Care of the acute respiratory Acute Nurse 5 patient in a general/respiratory (pages 11-15) ward Care of the acute respiratory patient with complex disorders and/or needs in a general/respiratory ward or specialist unit (e.g. high dependency) Acute Nurse 7 (pages 21-25) Respiratory Example Qualifications Skills 1, 3, 4, 5, Essential: Respiratory Assessment graduate diploma module 1, 3, 4, 5, 6, 7 Desirable: Graduate certificate or degree in respiratory disorders Essential: Respiratory Assessment graduate diploma module Respiratory Failure graduate diploma module Desirable: Graduate certificate or degree in respiratory disorders 9

10 Respiratory Specialist Nurses Responsibility/Role Roles Framework Level (minimum) Care of the respiratory patient in Respiratory 6 any setting support (pages 16-20) nurse/junior Respiratory CNS Respiratory Example Qualifications Skills 1, 3, 4, 5, Essential: Respiratory Assessment graduate diploma module Asthma graduate diploma module COPD graduate diploma module Respiratory Failure graduate diploma module Care of the respiratory patient with complex disorders/needs in any setting Care of the respiratory patient with complex disorders/needs in any setting. Responsible for leading a team. Care of the respiratory patient with complex disorders/needs in any setting. Responsible for leading a team. Respiratory CNS Lead Respiratory CNS Respiratory Nurse Consultant 7 (pages 21-25) 8 (pages 26-31) 9 (pages 32-37) Desirable: Graduate certificate or degree in respiratory disorders 1-7 Essential: Graduate certificate or degree in respiratory disorders Desirable: MSc 1-7 Essential: Graduate certificate or degree in respiratory disorders Desirable: MSc 1-7 Essential: MSc Desirable: PhD Contributes to the National Respiratory agenda. 10

11 Practitioner Level 5: Clinical Practice Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Demonstrates developing specialist knowledge, competence and clinical skills in Respiratory Care & Management appropriate to the patient s needs. Work under direction with limited freedom to exercise judgement about actions while accepting professional accountability and responsibility Works as part of a multi-disciplinary team, using and developing specialist knowledge and skills to provide clinical care. Promote clinical governance Work under direction with limited freedom to exercise judgement about actions while accepting professional accountability and responsibility Assume accountability and responsibility for delivery of agreed specific aspects of care including: Assessment Planning Defined areas of intervention Referral and discharge Improve health outcomes for individuals A broad knowledge and understanding of Respiratory Disorders underpinned by theoretical knowledge and relevant clinical experience, skills and competence Knowledge and understanding of clinical governance framework within own organisation, legislation, policies, procedures, protocols, professional regulation and codes of practice Works with patient group directions and/or standing orders Knowledge of range and needs of vulnerable and hard to reach groups Gains additional specific clinical competencies as required Core 1-6 HWB 1, 4, 6, 7 IK1 Ensures delivery and effective care using evidence-based practice Utilise critical thinking to explore and analyse evidence, cases and situations in clinical practice Draw on a range of sources in making judgements guided by senior colleagues within defined policies, procedures and protocols 11

12 Promote and influence others to incorporate non-judgemental, values-based care into practice Respect the dignity, wishes and beliefs of all patients involving them in shared decision making and obtaining their consent High level of awareness of own values and beliefs. Adherence to the NMC Code (2008) Core 6 Recognise and respect peoples diversity and perspectives Full understanding of informed consent and the implications of the Data Protection Act and Access to Medical Reports Act 12

13 Practitioner Level 5: Facilitation of Learning Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested Development of knowledge and skills in self, professionals and patients underpinned by the principles of teaching and learning Identify own training needs and that of some staff as delegated Participate in work based learning/teaching Supervising and assessing Pre-registration students and in the development of Clinical Support Workers Deliver Health Promotion and Education to patients Evaluate the effectiveness of education/ training interventions Presentation skills Apply the principles of life- long learning A broad knowledge and understanding of selfmanagement, including communication skills and motivational interviewing techniques Motivate, stimulate, encourage and facilitate the learning process Participate in action learning sets and clinical supervision Core teaching skills to support workplace learning links to KSF Core 1, 2, 4, 5 HWB 1, 4 Reflective practice 13

14 Practitioner Level 5: Research and Development Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested Access research/use information systems and enable/support others to use information systems to improve aspects of practice Participate in clinical audit to enhance the management of change Contribute to the development of local guidelines and policy Observe and record data as directed and for clinical trials and audits Knowledge of clinical audit and local NHS research governance policy Literature searching skills Ability to access and apply research Use information technology skills and systems links to KSF Core 1, 2, 4, 5 IK

15 Practitioner Level 5: Leadership Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested Team Work Work with others towards achieving shared goals Give and receive feedback in a constructive manner links to KSF Core 1, 2, 4, 6 Clinical Leadership Contribute towards the achievement of the teams purpose and objectives Recognise diversity, individual differences and perspectives Develop clinical leadership skills In conjunction with senior nurses, monitor and evaluate standards of care adhering to defined guidelines, policies standards and protocols to ensure the delivery of safe,effective and person centred care Motivation skills Knowledge, understanding and utilisation of KSF and its application Develop influencing, persuasion, organisation, and problem solving skills Foster skills in critical thinking, analysis and evaluation Apply local policy, protocol and standards Core 1-5 HWB 1, 6, 7 G6 Responsible for aspects of clinical effectiveness Participate in clinical supervision Identify and challenge poor performance and non-evidence based practice 15

16 Senior Level 6: Clinical Practice Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Demonstrates specialist knowledge, competence and clinical skills in Respiratory Care & Management appropriate to the patient s needs. Delivery and management in all contexts, appropriate to clients needs Practitioner must work as part of a team, using specialist knowledge and skills to provide and enhance clinical care Work within a clinical governance framework providing appropriate clinical supervision Assume accountability and responsibility for delivery of whole episodes of care including: assessment and diagnosis intervention referral and discharge improvement of health outcomes for individuals Detailed specialist knowledge of respiratory disorders underpinned by theoretical work and relevant clinical experience, competence and skills Knowledge and understanding of clinical governance framework within own organisation Work with patient group directions or Standing Orders Additional specific clinical competencies as required e.g. spirometry Core 1-6 HWB1-7 IK 1-2 Ensure delivery of safe and effective care using evidence informed practice Knowledge of range and needs of vulnerable and hard to reach groups Promote and influence others to incorporate nonjudgemental, values-based care into practice Works independently, has freedom to exercise judgement about actions, while accepting professional accountability and responsibility Work independently by virtue of specialist knowledge and skills e.g. Provision of Nurse led clinics Respect the dignity, wishes and beliefs of all clients involving them in shared decision making and obtaining their informed consent Utilise critical thinking to explore and analyse evidence, cases and situations in clinical practice. Draw on a range of sources in making judgements Freedom to act but is guided by precedent and clearly defined policies, procedures and protocols High level of awareness of own values and beliefs Recognise and respect peoples diversity, individual differences and perspectives Knowledge of legislation, policies, procedures, protocols, professional regulation and codes of practice Full understanding of informed consent and the implications of the Data Protection Act and Access to Medical Reports Act Core 1-6 HWB 3, 4, 7 Core 1-6 HWB 1, 6, 7 Manage team and/or resources to provide an ethical service within the context of national and Knowledge and understanding of clinical governance framework within own organisation 16

17 local policies/guidelines while remaining accountable for own professional practice 17

18 Senior Level 6: Facilitation of Learning Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Development of knowledge and skills in self, professionals and clients underpinned by the principles of teaching and learning Support the learning and development of some staff Participate in the creation of a learning environment that ensures effective learning opportunities for staff and students including: appropriate orientation and induction programmes range of clinical support strategies e.g. mentoring, coaching, clinical supervision and action learning Support ongoing mandatory training and relevant educational/ development opportunities Identify the training needs of self and some staff Presentation skills Apply the principles of life-long learning Motivate, stimulate, encourage and facilitate the learning process Uses self-management skills, including communication skills and motivational interviewing techniques Participate in action learning Core skills to support workplace learning Underpinned by theoretical knowledge and relevant clinical experience and competence Core 1, 2, 4, 5 G1 IK3 Undertake Personal Development Planning as delegated Participation in the teaching, supervision and assessment of Pre and Post Graduate students Evaluate the effectiveness of educational/ training interventions 18

19 Senior Level 6: Research and Development Aspects of Practice Examples of Sphere of Responsibility/ Role Key Knowledge Skills and Behaviours Suggested links to KSF Access research/use information systems and enable/support others to use information systems to improve areas of practice Initiate audit to enhance the management of change Contribute to the development of local guidelines and policy and where appropriate at Regional and National level Critical appraisal and evaluation skills Knowledge of clinical audit and local NHS research governance policy Literature searching skills Core 1,2,4,5 IK 2-3 Observe and record data using appropriate methods, tools and technology for complex audits, clinical trials or projects Contribute to or participate in audit and research as appropriate Ability to access research/ use information systems Information Technology Skills 19

20 Senior Level 6: Leadership Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Clinical Leadership Promote teamwork within defined area of responsibility In conjunction with senior nurses, monitor and evaluate standards of care adhering to defined guidelines, policies standards and protocols to ensure delivery of safe, effective and person centred care Responsible for aspects of clinical effectiveness Promote/undertake clinical supervision Possess organisational skills Skills in critical thinking, analysis and evaluation Report effectively for a range of complex situations and contexts Assess situations and identify the root causes of a complex problem Creativity and innovation in exploring and implementing possible solutions Core 1,2,4,5 IK 2-3 Identify and challenge poor performance and non-evidence based practice Evaluate solutions to make recommendations or decisions 20

21 Advanced Practitioner Level 7: Clinical Practice Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Demonstrate advanced competence, innovation and clinical leadership in Respiratory care delivery and management in all contexts, appropriate to clients, and wider work and health needs Work as part of a team, using advanced knowledge and skills to provide and enhance specialist clinical care Responsible for clinical governance within a defined area Assume accountability and responsibility for delivery of whole episodes of care including: assessment and diagnosis intervention referral and discharge improve health outcomes for individuals Highly developed specialist knowledge of respiratory disorders and relevant clinical experience and competence Knowledge and understanding of clinical governance framework within own organisation Assessment and diagnosis intervention, referral and discharge Additional specific clinical competencies as required Core 1-5 HWB 1, 3, 4 IK 2 G 2,7 Ensure delivery of safe and effective care using evidence informed practice Advanced knowledge of respiratory disorders Lead or contribute to Respiratory policy development and implementation Contribute to organisational policies in relation to employee health and wellbeing in the widest sense and use opportunities to influence others Promote and influence others to incorporate nonjudgemental, values-based Practice autonomously have freedom to exercise judgement about actions while accepting professional accountability and responsibility Negotiate care with clients as an equal partner. Puts the values, views and understanding of individual service users at centre of care Utilise critical thinking to explore and analyse evidence, cases and situations in clinical practice enabling a high level of judgement and decision making Freedom to act but is guided by precedent and clearly defined policies, procedures and protocols High level of awareness of own values and beliefs Works in a positive way with difference and diversity Knowledge of legislation, policies, procedures, protocols, professional regulation and codes of practice Core1-6 HWB 1, 4, 7 Core 1-6 HWB

22 Manage team and resources to provide an ethical service within the context of national and local policies/guidelines while remaining accountable for own professional practice 22

23 Advanced Practitioner Level 7: Facilitation of Learning Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Development of knowledge and skills in self, professionals and clients underpinned by the principles of teaching and learning Identify the training and development needs of self and staff Support the learning and development of all staff Create a learning environment that ensures effective learning opportunities for staff and students Undertake/lead a range of clinical support strategies e.g.(mentoring, coaching, clinical supervision and action learning) Responsible for team Personal Development Planning Participate in the teaching, supervision and assessment of Pre and Post Graduate students Plan and deliver Health Promotion and Education to patients Evaluate the effectiveness of educational/ training interventions Apply the principles of life-long learning Manage the learning environment Motivating, stimulate, encourage and facilitate the learning process Uses self-management skills, including communication skills and motivational interviewing techniques Participate in action learning Core skills to support workplace learning Encourage and undertake reflection on, and, in practice Advanced teaching and assessment skills Core 1,2,4,5 IK3 G 1, 6, 7 23

24 Advanced Practitioner Level 7: Research and Development Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Access research/ use information systems and enable/ support others to use information systems to improve areas of practice Act as a change agent, developing clinically effective practice through: effective utilisation and integration of evidence; setting, implementing and monitoring evidence informed policies, procedures and protocols Contribute to the research agenda through initiating audit/research Critical appraisal skills Knowledge of research governance Knowledge of clinical audit Literature searching skills Ability to access research/ use information systems Core 1-5 IK

25 Advanced Practitioner Level 7: Leadership Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Clinical Leadership Provide leadership across organisational teams in improving patient focussed care. Promote teamwork within defined area of responsibility Lead delivery of safe, effective and person centred care Responsible for clinical effectiveness Promote /undertake clinical supervision Possess excellent organisational skills Display skills in critical thinking, analysis Report effectively for a range of complex situations and contents Evaluate a variety of texts and make judgements based on a range of complex facts, options, analysis and interpretation Assess situations and identify the root causes of a complex problem Core 1-5 HWB 6-7 G 1, 66 Identify and challenge poor performance and non- evidence based practice Creativity and innovation in exploring and implementing possible solutions Political and strategic awareness Contribute to and enable delivery of identified area of Clinical Governance plan Ensure that organisational goals are reflected in personal and team objectives In partnership with a range of clinicians and managers demonstrate the ability to contribute to policy and strategy development at a departmental and organisational level and, where appropriate, national level Evaluate solutions to make judgements with incomplete or limited information Develop and maintain a working knowledge of local, national and professional strategy and policy. e.g. Health and Safety and Equality legislation, SIGN Guidelines, Nursing policies, NMC Regulation Healthy Working Lives and other associated Government initiatives Core 1-6 IK 3 25

26 Consultant Practitioner Level 8: Clinical Practice Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Demonstrate advanced competence, innovation and clinical leadership in RESPIRATORY care and delivery and management in all contexts, appropriate to clients Respiratory needs Practitioner will be able to work as part of a team using advanced knowledge and skills to provide and enhance specialist clinical care Highly developed specialist knowledge of Respiratory underpinned by theoretical knowledge and relevant clinical experience and competence Advanced knowledge of work related disorders Contribute to development of clinical governance frameworks Additional specific clinical competencies as required e.g. complex symptomatic testing and managing, dealing with distressing or highly distressing diagnoses or information which will impact on the health and employment of the client Core 1-6 HWB 1, 3, 4, 6, 7 IK 2 G 2, 7 Demonstrate advanced understanding and competency in legal and ethical complexities of Respiratory practice. Has developed expert understanding and networks Able to play a key role as part of a multidisciplinary team in the development, implementation and monitoring of ethical and legal strategies and policies at corporate and departmental level Knowledge of range and needs of vulnerable and hard to reach groups Knowledge of new and emerging guidance and legislation that govern legal and ethical aspects of respiratory practice Utilise the principles of clinical governance, clinical supervision and clinical audit to lead, manage and develop the ethical and legal aspects of safety and wellbeing Core 1,2,3,4,5,6 HWB 1, 3, 4, 6, 7 IK 3 G 2, 7 Generation of effective management reports and other forms of verbal, written and visual communication relating to the ethical and legal considerations of managing the health, safety and wellbeing of the working population 26

27 Promote and influence others to incorporate nonjudgemental, value-based care into practice Practice autonomously. Have freedom to exercise judgement about actions while accepting professional accountability and responsibility Act as a champion and role model for values based care and ensure that professional development and quality improvement plans reflect the importance of this approach to care Model and promote critical thinking to explore and analyse evidence, cases and situations in clinical practice enabling a high level of judgement and decision making. Has freedom to act guided by precedent and expert understanding of codes of practice, policies, guidelines, protocols and procedures High level of awareness of own values and beliefs Works in a positive way with difference and diversity Knowledge of legislation, policies, procedures, protocols, professional regulation and codes of practice Ability to develop, lead & establish protocols & procedures at operational & strategic levels, and to innovate, develop and lead on safe & competent practice Core 1-6 HWB 1, 4, 7 Core 1-6 HWB 6, 7 G 2, 7 Demonstrate ability to exercise advance levels of clinical decision making Provide leadership in the management of conflict relating to confidentiality of data collection, recording, retrieval and dissemination 27

28 Consultant Practitioner Level 8: Facilitation of Learning Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Development of knowledge and skills in self, professionals and clients underpinned by the principles of teaching and learning Design, plan, implement and evaluate learning and development programmes Work collaboratively with Higher Education Institutions, work and with Stakeholders to review and develop appropriate respiratory programmes/ training Motivate, stimulate, encourage and facilitate the learning process Participate in action learning Core skills to support workplace learning and assessment Core 1,2,4,5 IK 3 G 1, 6, 7 Manage and develop the learning environment Reflective Practice In response to strategy, policy and client need, plan and deliver educational interventions at a local and national level informed by training needs analysis Evaluate the effectiveness of educational/ training interventions 28

29 Consultant Practitioner Level 8: Research and Development Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Promote and undertake nursing research Ensure that services are based on high-quality evidence Identify gaps in the evidence base and communicate findings to appropriate clinical, policy and research communities Knowledge of research governance Critical literature reviewing skills including the ability to analyse, synthesise and interpret the evidence base to underpin practice within respiratory Core 1,2,4,5 IK 2, 3 Collaborate with appropriate research partners and build links with Research Forums and universities e.g. Research Consortia Initiate, facilitate or undertake appropriate highquality research acting as principal investigator where appropriate Contribute to development and implementation of a work and health nursing research strategy Present research findings in peer reviewed journals, conference and meetings Skills in writing for publication Excellent Presentation Skills Knowledge of research proposal and funding processes Knowledge of the ethical application process Ability to gather, collate and communicate appropriate clinical data to enable audit, service evaluation and clinical research model, establishing appropriate policies and ensuring support for clinical research activity. Develop a research culture within the NMAHP community, acting as a role model 29

30 Consultant Practitioner Level 8: Research and Development Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Change Management Identify need for change. Change management skills Core 1, 2, 4 Lead and manage change at a National and Local level. Leadership skills G 2-7 IK 2 Networking Negotiating and Influencing Monitor the effectiveness and impact of change Network with a wide range of organisations and individuals to shape and respond to Policy and Strategy at a National and Local level. Represent respiratory nurses widely, nationally and internationally Identification of key stakeholders Participate and influence National and Local policy making activities, which relate to the sphere of professional practice by supporting and developing lateral thinking in self and others Influencing skills Advanced communication and interpersonal skills Presentation and report writing skills Understanding and identifying spheres of influence Listen to, and understand complex information both implicit and explicit Listen to, and appreciate the complexity of a range of views, adopt effective questioning techniques Core 1, 2, 4, 5 G 1 Core 1, 2, 4, 5, 6 Specific G 2, 3, 5, Display a sensitive manner and use appropriate language within a range of situations Team Development Act as a positive role model Support teams in their development by developing networks and sharing information Act as a coach and mentor Business planning and people management including workforce development and succession planning Develop the strategic management of specialist teams by sharing information and expertise Core 1, 2, 4, 5 G 1, 6 Model behaviours that value diversity, individual differences and perspectives Motivation skills 30

31 Clinical Leadership Provide Leadership across professions and organisational teams in improving client focused care Contribute to the strategic review of clinical effectiveness Develop and lead respiratory audit and problem solve in an ethical, reflective and evidence based manner Ensure provision of clinical supervision Organisational skills Possess excellent organisation skills Display skills in critical thinking, analysis and synthesis Report effectively for a range of complex situations and contexts Readily use highly specialised theoretical practice and knowledge to think, gain and share information, solve problems and make decisions. Core 1, 2, 3, 4, 5 HWB 1, 3, 6, 7 G 1, 6 Political and strategic awareness Ensure delivery of a clinically excellent high quality respiratory services Identify and challenge poor performance and non-evidence based practice Ensure that organisational goals are reflected in own and others objectives Work collaboratively across boundaries to develop and raise awareness of relevant policies, guidelines and strategies and influence change at local and national level Identify and act on opportunities to influence and development of policy and guidelines Assess situations and identify the root cause of a complex problem in environments that are unfamiliar, complex and unpredictable and have many interacting factors Maintain a working knowledge of local, national and professional strategy and policy Critical reading skills, ability to analyse and synthesise information Ability to interpret health information, statistics and research data Core 1-6 IK 3 Respond to national and local requests for document review (e.g. strategy, policy guidelines) 31

32 Senior Practitioner Level 9: Clinical Practice Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Demonstrate advanced/ expert competence, innovation and clinical leadership in delivery and management of services in all contexts, appropriate to clients and organisational needs Lead and work as part of a specialist respiratory team using advanced knowledge and skills to provide and enhance specialist clinical care Provide leadership and management and have responsibility for ensuring development and delivery of the clinical governance plans for the team Display highly developed and extensive specialist knowledge of respiratory disorders underpinned by theoretical expertise, and knowledge with relevant in depth clinical experience, competence and skills Lead on development of clinical governance frameworks Plan and lead the delivery of a multifunctional service to encompass the needs for a diverse organisation (s) Additional specific clinical competencies as required e.g. management of complex and/or high profile clients or situations. Core 1-6 HWB 1, 3, 4, 6, 7 IK 2 G 2, 7 Demonstrate highly advanced specialist understanding and competency in respiratory care and management Has developed expert understanding and networks at a local and national level Lead and advise at departmental, operational, strategic and organisational levels Utilises evidence based practice to guide interpretation of statutory and advisory guidance to ensure the health of patients and staff Knowledge of range and needs of vulnerable and hard to reach groups Knowledge of emerging guidance and legislation that govern legal and ethical aspects of respiratory practice Able to utilise the principles of clinical governance, clinical supervision and clinical audit to lead, manage and inform ethical and legal aspects of respiratory practice Core 1-6 HWB 1, 3, 4, 6, 7 IK 3 G 2, 7 Generation of effective management reports and other forms of verbal, written and visual communication relating to the ethical and legal considerations of managing the health, safety and wellbeing of the working population 32

33 Promote and influence others to incorporate nonjudgemental, value-based care into practice Act as a champion and role model for values based care and ensure that professional development and quality improvement plans reflect the importance of this approach to care High level of awareness of own values and beliefs Works in a positive way with difference and diversity Core 1-6 HWB 1, 4, 7 33

34 Senior Practitioner Level 9: Facilitation of Learning Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Development of knowledge and skills in self, professionals and clients underpinned by the principles of teaching and learning Design, plan, implement and evaluate learning and development programmes Initiate and lead on collaborative working with Higher Education Institutions Work with a range of stakeholders to review and develop appropriate respiratory programmes/ training Create an ethos in the organisation which creates and values a positive learning environment In response to strategy, policy and client need, plan, develop and deliver educational interventions at a local and national level informed by training needs analysis Evaluate the effectiveness of educational/ training interventions Motivate, stimulate, encourage and facilitate the learning process Ability to lead and participate in action learning Demonstrate high level skills to support workplace learning and assessment Demonstrate skilled reflective practice and ability to engage others in this process Core 1, 2, 4, 5 IK 3 G 1, 2, 6, 7 34

35 Senior Practitioner Level 9: Research and Development Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Promote and undertake nursing research Ensure that services are based on high-quality evidence Identify gaps in the evidence base and communicate findings to appropriate clinical, policy and research communities and provide options for projects and programmes Collaborate with appropriate research partners and build links with Research Forums and Universities e.g. Research Consortia Initiate, facilitate or undertake appropriate highquality research acting as principal investigator where appropriate Advanced knowledge of research governance Critical literature reviewing skills including the ability to analyse, synthesise and interpret the evidence base to underpin practice within the health & work area Skills in writing for publication Excellent Presentation Skills Knowledge of research proposal and funding processes Knowledge of the ethical application process Core 1-6 IK 2, 3 G 2, 7 Contribute to development and implementation of a work and health nursing research strategy Present research findings in peer reviewed journals, conference and meetings Ability to gather, collate and communicate appropriate clinical data to enable audit, service evaluation and clinical research Develop a research culture within the NMAHP community, acting as a role model, establishing appropriate policies and ensuring support for clinical research activity 35

36 Senior Practitioner Level 9: Leadership Aspects of Practice Examples of Sphere of Responsibility/Role Key Knowledge Skills and Behaviours Suggested links to KSF Change Management Networking Identify need for change at all levels in an organisation Lead and manage change at a National and Local level Monitor the effectiveness and impact of change using evidence based tools Network with a wide range of organisations and individuals nationally and internationally to shape and respond to Policy and Strategy at a National and Local level Advanced change management skills Advanced Leadership skills Advanced influencing skills Advanced communication and interpersonal skills Core 1, 2, 4 G 2-7 IK 2 Core 1, 2, 4, 5 G 1 Negotiating and Influencing Team Development Represent Respiratory nurses and nursing widely nationally and internationally Identification of key stakeholders in an organisation that may cross professional boundaries Participate and influence National and Local policy making activities, which relate to the sphere of professional practice by supporting and developing lateral thinking in self and others Share expertise with non NHS organisations and lead on the marketing, costing, delivery and monitoring of contracts as appropriate Act as a positive role model and leader Support teams in their development by developing networks and sharing information Act as a coach and mentor to a wide range of staff Presentation and report writing skills for publication nationally and internationally Understanding and identifying spheres of influence across organisational and professional boundaries Listen to, and understand complex information both implicit and explicit Listen to, and appreciate the complexity of a range of views, adopt effective questioning techniques Display a sensitive manner and use appropriate language within a range of situations Business planning and people management including workforce development and succession planning Develop the strategic management of specialist teams by sharing information and expertise Model behaviours that value diversity, individual Core 1, 2, 4, 5, 6 IK 3 G 2-7 Core 1, 2, 4, 5 G 1, 6 36

37 Clinical Leadership Use workforce planning methodology to enable succession planning Operates independently manages department interprets organisational policies Provide highest level leadership across professions and organisational teams in improving client focused care Lead on the strategic review of clinical effectiveness of respiratory services Develop and lead respiratory audit and problem solving in an ethical, reflective and evidence based manner Ensure provision of clinical supervision differences and perspectives Motivation skills Organisational skills Possess excellent organisation skills Display skills in critical thinking, analysis and synthesis Report effectively for a range of complex situations and contexts Display expertise in utilising highly specialised theoretical and practice knowledge to think, gain and share information, solve problems and make decisions. Core 1-6 HWB 1, 3, 6, 7 G 1-6, 8 Political and strategic awareness Ensure delivery of a clinically excellent high quality service in work and health services in line with Healthcare Quality Strategy Identify, challenge and manage poor performance and non-evidence based practice, acting as a key change agent where required Ensure that organisational goals are reflected in own, others and departmental objectives Work collaboratively across boundaries leading on development, implementation and awareness raising of relevant policies, guidelines and strategies and influence change at local and national level Identify and act on opportunities to influence and development of policy and guidelines Assess situations and identify the root cause of a complex problem in environments that are unfamiliar, complex and unpredictable and have many interacting factors. Demonstrate advanced working knowledge of local, national and professional strategy and policy Display highly developed critical reading skills, ability to effectively analyse and synthesise information Advanced ability to interpret health information, statistics and research data Core 1, 2, 4, 5 IK 3 G 1, 2, 6, 7 Respond to and lead on, national and local requests for document review (e.g. strategy, policy guidelines) 37

38 Skills Guide This section outlines essential elements that should be included in courses that teach respiratory skills. 38

39 Skill 1: Basic Respiratory Assessment Outcome: The clinician demonstrates the ability to perform a basic respiratory assessment, interpret results in conjunction with the clinical picture and discusses rationale for actions taken. Practice Learning Achievement Demonstrates correct methods for assessing respiratory status respiratory rate depth pattern adventitious sounds speech (ability to complete sentences) mental status (confusion, agitation, changes in consciousness) cardiovascular assessment Demonstrates correct procedure for recording oxygen saturation (Sp0 2 ) ensures oximeter is in good working order (casing, probe and wiring are intact) ensure probe is clean/cleans probe with alcohol wipe explains reason for measurement to patient looks for a suitable site - should be warm and well perfused (if using finger, removes dirt or dark nail polish, checks pulse for strength and rhythm) leaves probe on for a minimum of 30 seconds Recognises limitations of pulse oximetry knows that it does not record haemoglobin, carbon dioxide/hydrogen ion levels, or ph knows that smoking can give false high readings knows that dirt, dark nail polish, poor circulation, hypotension, hypovolaemia, arrhythmia, cold peripheries, shivering and movement can result in inaccurate measurement Interprets Sp0 2 results in conjunction with the clinical picture and discusses rationale for action(s) taken obtains guidance on acceptable Sp02 parameters for patient (e.g. keep stats between 92-95%) with medical staff/respiratory specialist interprets results in conjunction with clinical picture (compares with patients normal steady state, if different discusses rationale for action(s) taken) discusses abnormal results with medical staff/respiratory specialists Demonstrates accurate documentation in appropriate charts/notes, complies with NMC standards. oxygen prescription chart medical early warning scoring chart nursing notes Candidate Signature Assessor Initial Date 39

40 Skill 2: Spirometry Aim: The clinician demonstrates correct procedure for performing spirometry and analyses results correctly. Practice Learning Achievement Recalls contra-indications for spirometry: MI in last 3 months head, abdominal or thoracic surgery in the last 3 months refuses if is experiencing complications of surgery done more than 3 months ago CVA in last 3 months haemoptysis of unknown origin unstable cardiovascular disorders (e.g. angina, hypertension) current exacerbation of COPD Demonstrates correct technique(s) for calibration uses a 1 or 3 litre syringe, or physiological control follows instructions given by spirometer analyses results refrains from using if calibration fails (or >5% variation in readings from previous calibration) Demonstrates compliance with quality control procedures, keeps a quality control book and records: cleaning calibration software changes Demonstrates awareness of infection control issues and takes necessary precautions uses one way valve cleans spirometer in accordance with manufacturers instructions uses single-use disposable mask for reversibility testing does not perform spirometry on patients who have haemoptysis of unknown origin, active TB or other transmittable respiratory infection Practices spirometry safely and correctly reviews contraindications with patient demonstrates manoeuvres to patient uses nose clip for VC manoeuvre removes nose clip for FVC observes manoeuvres and corrects mistake performs a minimum of 3 and max of 8 manoeuvres ensures good start of test criteria is met ensures good end of test criteria is met Candidate Signature Assessor Initial Date 40

41 obtains 3 good readings with < 5% variation Interprets spirometry correctly recognises normal, obstructive and restrictive patterns differentiates between obstructive and restrictive flow volume loops and curves correctly calculates reversibility identifies when reversibility is irreversible, partially reversible or completely reversible Interprets spirometry in conjunction with the clinical history is able to differentiate between asthma and COPD discusses diagnosis/differential diagnosis with medical staff 41

42 Skill 3: Inhaler and Nebuliser Therapy Aim: The clinician demonstrates knowledge of inhaled drugs and devices used in the management of COPD. Practice Learning Achievement Demonstrates ability to titrate inhaler therapy in accordance with national/local COPD guidelines increases therapy appropriately discontinues inappropriate/ therapy Discusses mode of action and side effects of: short- and long- acting B 2 agonists short- and long- acting antimuscarinic bronchodilators inhaled corticosteroid combination inhalers oral theophylline Demonstrates correct inhaler technique(s) for: accuhaler breezhaler easi-breath easyhaler handihaler metered dose inhaler, with and without spacer respimat turbohaler Identifies and corrects poor inhaler technique such as not loading device properly poor inspiratory effort lack of co-ordination of actuation with inspiration Identifies poor/problems with compliance and discusses sensitively with patient uses self-management skills to help patient problem solve Recognises criteria for nebuliser therapy patients with distressing and/or disabling breathlessness despite compliance with maximal inhaler and oral therapy or unable to use inhalers Is able to instruct patient on correct use of nebuliser therapy, equipment and sundries ensures patient follows manufactures instructions when operating and cleaning the compressor and nebuliser ensures patient is aware of importance of minimal and maximal fill levels of nebuliser ensures self and patient aware of procedure for replacing/renewing compressor and nebulisers Candidate Signature Assessor Initial Date 42

43 Skill 4: Oxygen (0 2 ) Therapy Aim: The nurse/ahp is able to identify criteria for Long-Term Oxygen Therapy (LTOT) and safely monitor the patient on LTOT. Practice Learning Achievement Uses pulse oximetry and clinical assessment to identify need for LTOT in accordance with national/local guidelines (see skill 1) Knows criteria for oxygen prescription. Non-smokers with any (not all) of the following: severe airflow obstruction (FEV1 < 30-49% predicted) oxygen saturations 92% breathing air polycythaemia peripheral oedema cyanosis a raised jugular venous pressure Uses pulse oximetry and clinical assessment to assess and monitor the patient prescribed LTOT (see skill 1) Recognises deterioration in patient s condition and takes appropriate action, e.g. assesses palliative care needs refers to nurse with advanced skills, Respiratory CNS or GP if unable to manage symptoms Instruct patient on correct use of oxygen therapy equipment and sundries including: dangers of smoking correct storage/placement of equipment including fire risk tampering with equipment increasing flow of oxygen without medical supervision care of tubing when ambulatory to prevent falls and trips Ensures self, patient and carer is aware on correct use of oxygen alert card Ensures self and patient aware of procedure for replacing/renewing sundries and equipment Ensures self and patient aware of procedure for reporting problems with oxygen concentrator or cylinder uses information on concentrator Informs prescriber of continued smoking and documents accurately in nursing notes Candidate Signature Assessor Initial Date 43

44 Skill 5: Indwelling Pleural Catheter (IPC) Outcome: The clinician demonstrates that they are able to adhere to the Insertion and Care of Chest Drains Integrated Care Pathway, recognise the complication of IPC and take the appropriate action. Practice Learning Achievement Is able to explain the anatomy and physiology of the pleura, must include that it is: a double membrane that encloses and protects the lungs the pleural cavity lies between the membranes and contains a small amount of serous fluid that prevents friction between the membranes during pulmonary ventilation the pressure within the pleural cavity is always negative which keeps the alveoli open an increase in pleural pressure may cause the lung to collapse the pleural cavity is not an actual but a potential space Is able to Lists indications for indwelling pleural catheter, must include: pneumothorax (air in the pleural space) pleural effusion (increase in pleural fluid in the pleural cavity) Demonstrates that they are able to safely maintain an indwelling pleural catheter, must adhere to must adhere to local protocols relating to ICP, infection control and waste disposal Demonstrates that they are able to assess the patients with an indwelling pleural catheter, must carry out a respiratory assessment (see skill 1) Recognises complications and takes the appropriate action, must include: recognises signs and symptoms of infection and takes appropriate action recognises signs and symptoms of tension pneumothorax and takes appropriate action recognises signs and symptoms of surgical emphysema and takes appropriate action identifies when to call a senior medic for help Demonstrates accurate documentation in appropriate charts/notes Candidate Signature Assessor Initial Date 44

45 Skill 6: Arterial Blood Gas (ABG) Sampling & Analysis Outcome: The clinician demonstrates that they are able to safely sample and interpret arterial blood gas results in conjunction with the clinical picture. Practice Learning Achievement Is able to recall the physiology of respiration pulmonary ventilation external respiration internal respiration factors that affect airway resistance and compliance pulmonary circulation control of respiration Identifies pathophysiological factors that influence gas exchange including ventilation/perfusion mismatch common disease processes including COPD and Asthma Demonstrates conformity to local board policy/protocol/guidance when: identifying indications and contraindications to ABG sampling disposing of sharps & clinical waste dealing with a needle stick injury or infection control issues Demonstrates that they are able to safely obtain an arterial blood gas sample communicating need with patient obtaining consent from patient identifies a suitable sample site, performs the Allen Test/checks for collateral circulation safely obtains sample applies adequate pressure to site disposes of sharps and clinical waste as per board policy/protocol/guidance Is able to recognises normal and abnormal ABG results including metabolic acidosis respiratory acidosis metabolic alkalosis respiratory alkalosis Recognises common conditions that may cause abnormal ABG results including respiratory failure due to COPD respiratory failure due to obstructive sleep apnoea pneumonia asthma Candidate Signature Assessor Initial Date 45

46 hyperventilation diabetic ketoacidosis Interprets ABG results in conjunction with the clinical picture and discusses rationale for action(s) taken alters treatment if appropriate/within their capability communicates with patients and/or carer communicates with nursing and medical staff Demonstrates accurate documentation in appropriate charts/notes records whether taken on air or oxygen, and percent/litres of oxygen records outcome of discussions with patient, carers, nursing and medical staff records date and time signs documentation 46

47 Skill 7: Non-invasive Ventilation (NIV) Outcome: The clinician demonstrates that they are able to safely initiate and manage the patient requiring non-invasive ventilation Practice Learning Achievement Is able to recall the physiology of respiration pulmonary ventilation external respiration internal respiration factors that affect airway resistance and compliance pulmonary circulation control of respiration Identifies common conditions & pathophysiological processes that lead to respiratory failure, must include COPD Obstructive Sleep Apnoea Demonstrates conformity to local board policy/protocol/guidance when: identifying indications and contraindications to NIV disposing of equipment dealing with infection control issues Demonstrates that they are able to safely initiate NIV communicating need with patient obtaining consent from patient selects and correctly fits an appropriate interface safely sets up the circuit including oxygen safely sets the machine to synchronise with patient, adjusting IPAP, EPAP, Rise and Respiratory Rate accordingly Demonstrates safe monitoring of the patient monitors respiratory status monitors cardiovascular status monitors ABGs (see skill 12) Identifies complications and resolves assesses patient to ensure no deterioration in clinical condition assess the interface and circuit, and alters if needed assess the settings and alters if needed Identifies and communicates an appropriate course of action based on clinical condition/abg results alters treatment if appropriate/within their capability communicates with patients and/or carer communicates with nursing and medical staff Candidate Signature Assessor Initial Date 47

48 Supporting Implementation Local Support Support can be obtained from your local SRNF committee member. Higher Education Institutions The following educational institutions offer graduate diploma, degree and MSc certificates. West of Scotland University Your NHS Board may have a Service Level Agreement (SLA) which means that you will be able to access courses for free. If your NHS Board does not have a SLA, then visit the UWS for information on funding. One module costs approximately Education for Health Courses are run in Stirling. One module costs approximately 670. Consult your manager for funding. Respiratory Education UK Courses are not run in Scotland unless a satellite course is organised. One module costs approximately

49 Appendix 1 49