a framework for palliative care - cancerni.net care competencies rcn project.pdf · a framework for...

A frameworkfor nursesworking inspecialistpalliative care

Competencies Project

Competencies in nursing

The following people formed the RCN Hospice NurseManagers Forum Competency Action Group:

Penny Anning, Chair, Hospiscare, Exeter, Devon

Sue Bowen, Secretary, Macmillan Services KingEdward V11, Midhurst, Sussex

Hillary Holman, St Peter’s Hospice, Bristol

Kay Leedham, Katharine House Hospice, Banbury

Maria McGill, Marie Curie Centre, Glasgow.

We would like to offer our grateful thanks to:

The Cancer Care Alliance, the RCN Nurses ManagingHospice and Specialist Palliative Care Services Forum,the specialist palliative care organisations that gavefreely of the competency work they had alreadyundertaken, all those who commented on the originaldraft, and Christine Vincent Smith for her typing andorganisational skills that kept us on track.

Acknowledgements

R O Y A L C O L L E G E O F N U R S I N G

1

A framework for nurses working inspecialist palliative careCompetencies Project

ContentsIntroduction 2

Development of the framework 2

How to use this framework 3

Levels of practice 3

Provision of evidence 4

References 5

Competency statements 6

– communications skills 6

– quality assurance 9

– clinical practice, job knowledge and skill 11

– education 13

– management and leadership 15

– research and development 17

– grief, loss and bereavement 19

Competencies in nursing N U R S E S W O R K I N G I N S P E C I A L I S T P A L L I A T I V E C A R E

2

1 2

IntroductionSpecialist palliative care aims to provide relief fromsuffering and improve the quality of life for bothpatients and their families. It takes a holistic approach,acknowledging that suffering is more than physicaldistress, and recognising that the patient requires acombination of physical, psychological, social andspiritual care.

This project’s overall aim is to develop the competenciesrequired by qualified and unqualified nurses practisingwithin a specialist palliative care environment,including the possibility of adaptation and use within aspecialist palliative children’s hospice.

The availability of a highly skilled and educatedworkforce in order to provide high quality serviceprovision has been recognised by specialist palliative careproviders as pivotal in taking the service forward. It hasalso been cited in numerous documents, for example:

✦ Calman Hine report (1995)

✦ Palliative care 2000 (2000)

✦ The cancer plan (2000)

✦ The national service framework for cancer care (2001)

✦ Care Standards Commission Minimum standards forhospice and palliative care services (2001).

The framework described here suggests the minimumstandards of care to be delivered by palliative carenurses. It can be used as a guide to help staff andmanagers identify training and educational needs.

Competence The term ‘competence’ has been defined as: “The skills,knowledge, experience, attributes and behavioursrequired by an individual in order to perform the jobeffectively”.

The principles on which this publication’s competenciesare based include:✦ all patients should have access to a uniformly high

quality of care in primary and secondary caresettings

✦ specialist palliative care services should be patient-centred and take into account the needs of familiesand carers

✦ nationally agreed standards for education andpractice for nurses working in this area should beformulated.

Development of theframeworkSupported and resourced by the Royal College ofNursing (RCN), this framework has been developed byan action group of hospice nurse managers andeducationalists working in the practice area of specialistpalliative care.

Initially, work included a literature search on thedevelopment of competencies and any existingframeworks. Following this, the Cancer Care Alliancegave permission to adapt their framework. An especiallyencouraging response was received from specialistpalliative care providers, with examples of their goodwork reflected in this document.

Having agreed core competencies, the format and levelon which they should be based was carefullyconsidered. The knowledge, skills and behaviouralapproach was adopted and, following the Cancer CareAlliance, it was decided to group these within four levelsof competence. The content of the competencystatements provoked much discussion. Finally, it wasagreed that they should not include specific areas ofpractice - such as the use of syringe drivers - although itwas recognised that this would need to be pursed atlocal level. Readers should note that the competenciesare cumulative in nature, which means that level 2nurses would be expected to achieve their own gradecompetencies, in addition to those of level 1.

Each member of the working group had specific corecompetencies to develop. These were then drafted by thechair and sent to group members for comment. Afterbeing considered by the RCN’s Accreditation Unit, thedocument was distributed to regional hospice nursemanager chairs for further consultation and finalamendments.


3

3 4

How to use thisframework There are a number of ways this framework can be usedto develop nurses’ knowledge and skills. Here are someexamples.

✦ A formal appraisal system to assess competence andidentify training needs.

✦ A plan for team training, enabling the line managerto assess the team’s competence and training needs,encompassing appropriate skill mix.

✦ A mechanism to help individuals assess their owncompetence and training needs.

✦ A means of planning an individual’s career pathway.

✦ A method of developing a comprehensive inductionprogramme for new staff.

It is expected that nursing staff at all levels will use thisframework, in conjunction with more senior staff.

Levels of practiceFour levels of competency have been identified thatcorrelate with the current grading system and withproposals from the Nursing and Midwifery Council(NMC) on the development of nursing and thepractitioner, specialist and consultant roles.

Level 1: Support worker or health careassistantProvides basic specialist palliative care withresponsibility to a registered practitioner. Thiscorresponds to grades A and B.

Qualification:S/NVQ level 2 or working towards.Evidence of attendance at a communication skillsworkshop.

Experience:Two years working in a health or social careenvironment.

Level 2: Qualified nurseA practitioner with a range of nursing experience whohas started training in specialist palliative care, whilstworking with responsibility to an experiencedpractitioner. This corresponds to grades D and E.

Qualification:Registered nurse level 1 or 2.Palliative care module at diploma level orworking towards.

Experience:To be determined locally.

Level 3: Senior qualified nurse An experienced practitioner, with a recognisedspecialist palliative care qualification, who routinelyuses their specialist skills. This corresponds to grades Fand G.

Qualification:Registered nurse level 1.A qualification at diploma level in specialist palliativecare or related subject whilst working towards degreelevel.

Experience:Two years working in a specialist palliative careenvironment.


4

Level 4: Specialist nurse An experienced nurse in the field of specialist palliativecare, who leads and supports the team whilst developingpractice. They will be working towards or have achieveda specialist degree. This corresponds to grades H and I.

Qualification:Registered nurse level 1.Working towards or have achieved a specialist award at masters level, including a teaching module.If managing specialist palliative care services, it isexpected that the nurse will have a managerialmodule at degree level.

Experience:Five years in a specialist palliative care environment.

Provision ofevidenceRather than incorporate the evidence needed to achievecompetency within the statements, the following listwas agreed. Bear in mind that these suggestions are notexhaustive.

✦ Excerpts from a reflective diary, with self-assessmentof competence, identified development needs and anaction plan.

✦ Observation and critical analysis of everyday practice.

✦ Testimony of the individual’s contribution to nursingpractice – for example, the co-ordination of caremanagement for one or a group of patients.

✦ Active contribution to policy groups, developing orrevising guidelines, standards, audits.

✦ Change or project management.

✦ Certificate of attendance and an evaluation of theoutcomes of study days or courses.

✦ Demonstration of evidence-based practice, withsupportive literature, protocols etc.

✦ Planning, delivering and evaluating teachingsessions.

✦ Individual performance review.

✦ Personal and professional development portfolio.

✦ Active involvement in clinical supervision,mentorship, multidisciplinary meetings.

✦ Proven ability to successfully plan discharges.

✦ Demonstrable ability to liaise with themultidisciplinary team and external agencies.

✦ A relevant contribution to a verbal discussion aboutpatient care that is appropriate for the individual’slevel.

✦ Contribution to local or national documents orjournals about service delivery, education etc.

✦ Leading or contributing to a journal club or other in-house teaching and learning sessions.

✦ Written documentation about patient care that isappropriate for the individual’s level.

5


5

ReferencesCancer Care Alliance (1999) Cancer care standards,University of Teeside, South Durham & North Yorkshire.

Coit-Butler F (1978) The concept of competence: anoperational definition, Educational Technology, 18 7-16.

Department of Health (1995) Calman Hine Report,London: DH.

Department of Health (2000) The cancer plan, London:DH.

Department of Health (2001) Cancer in Scotland: actionfor change, Edinburgh: Scottish Executive.

Department of Health (2001) The national serviceframework for cancer care, London: DH.

Department of Health (2002) Independent health carenational minimum standards, London: DH.

Mount Vernan Centre for Cancer Treatment (1999)Cancer nursing strategy, Hertfordshire: WestHertfordshire NHS Trust.

National Council for Specialist and Palliative CareServices (2000) Palliative Care 2000, London: BritanniaStreet.

Nursing and Midwifery Practice Development Unit(2001) Standardising job titles, Edinburgh: Elliott House.

6

6

Competency statements

Competency area: communication skills

This includes: verbal communication, written communication, interpersonal skills, non-verbal communication,interviewing skills and team skills.

communication skills: Level 1The staff member communicates effectively, demonstrating talking and listening skills. They are able to respond

appropriately to the specific needs of patients with advanced illness and those close to them.


KNOWLEDGE COMPETENCIES SKILLS BEHAVIOUR

✦ Aware of the palliative care approachand its significance in informing anappropriate communication process

✦ Aware of the processes that lead toeffective listening and informationgiving

✦ Understands the boundaries of thehealth care assistant and patientrelationship

✦ Understands the importance ofconfidentiality, knowing when todisclose information appropriately tostaff, patients and carers

✦ Contributes to multi-professionalworking

✦ Communicates simple information,verbally or in writing, to othermembers of the team

✦ Builds a rapport with patients,relatives and other team members

✦ Empathetic, sensitive and realistic inencouraging and supporting patientswhen giving general care in a palliativecare setting

✦ Utilises resources appropriately toaddress impediments tocommunication that may result fromdisease, hearing, speech, language, etc

✦ Uses interpersonalskills

✦ Sensitive

✦ Compliant

✦ Demonstratesintegrity


7

communication skills: Level 2The staff member uses a variety of communication skills - for example, verbal, written and non-verbal - and has

knowledge of their complexity. They use documentation to reflect the intricate nature of information required to carry

out and co-ordinate care.


✦ Aware of skills, interactions andtheoretical models that underpineffective communication in palliativecare

✦ Understands the impact that thehealth care assistant’s communicationand approach may have on the well-being of the patient and carer

✦ Knows the principles and aims ofcaring for patients with complex needs- for example, psychological issues ofanger, denial etc

✦ Aware of the main local, regional andnational support groups

✦ Knows about patient or user initiatives

✦ Assesses, plans, implements, evaluatesand documents the care of patientswith a range of problems or issues

✦ Recognises the opportunity, by pickingup cues, to hold deeper discussionsrelating to psychological, emotional orspiritual issues

✦ Confidently facilitates and managesinteractions with patients and families

✦ Contributes to multidisciplinaryplanning and decision-makingmeetings

✦ Assertive

✦ Uses initiative

✦ Confident

✦ Self-aware

communication skills: Level 3The staff member uses their specialist knowledge and communication skills to promote open and honest interactions

that recognise the individual needs of patients with advanced disease, those close to them and other professionals.


✦ Knows about disease trajectories andtreatment effects

✦ Understands the therapeutic nature ofnursing and the impact of the nurseand patient relationship

✦ Knows about counselling approaches

✦ Understands the role of patient or userinvolvement in specialist palliativecare

✦ Supports patients and familiesthrough uncertainty, using knowledgeof the impact of disease and itstreatment to discuss care options andcoping strategies

✦ Identifies and deals confidently withissues on the patient’s agenda that maypotentially lead to psychologicalmorbidity, referring to colleagues, asappropriate

✦ Creates an empowering and affirmingenvironment. Suggests a range ofoptions and goals, whilst working withpatients and relatives to make theirown choices

✦ Creative

✦ Influential in a one-to-one situation or asmall group

✦ Supportive


8

Level 4The staff member establishes a therapeutic relationship in which they are able to utilise counselling skills to assist the

individual to adjust to their illness and care.


✦ Knows the theory and practice oftherapeutic nursing relationships

✦ Knows counselling techniques

✦ Understands family dynamics, andtheories and models for supportingfamilies in crisis

✦ Analyses complex patient situationsand shares experiences and insightswith others

✦ Guides and supports others to improvecommunication skills amongst theteam

✦ Teaches communication skills informal settings to specialist and non-specialist staff

✦ Creates an environment that allowsnurses to develop therapeuticrelationships and enables junior staffto share their views of patient issues inmultidisciplinary meetings

✦ Influential

✦ Exercisesjudgement


9


✦ Familiar with the Nursing andMidwifery Council’s (NMC) Code ofprofessional conduct and Code ofpractice

✦ Understands the principles of clinicalgovernance and quality assurance

✦ Recognises the need for reflection tomaintain standards and uses theprocess of significant event analysis

✦ Recognises the need for continuingprofessional development andevidence-based practice

✦ Aware of the impact of an ineffectualuse of resources

✦ Identifies unsafe practice andresponds appropriately

✦ Undertakes risk assessments

✦ Assesses own performance againstminimum standards

✦ Actively contributes to programme ofclinical audit

✦ Recognises own and others’ limitations

✦ Manages resources effectively

✦ Accesses and uses evidence-basedpractice


✦ Committed

✦ Accountable

✦ Confident


✦ Aware of the needs of palliative carepatients

✦ Understands the principlesunderpinning the risk assessmentprocess

✦ Aware of the importance of accuraterecord keeping

✦ Aware of organisational policies,procedures and protocols

✦ Understands and only undertakesactivities they are trained andcompetent to perform

✦ Participates in simple audit projects,under supervision

✦ Identifies and accurately reports anyaccidents or incidents

✦ Reports any concerns or issues tosenior staff

✦ Identifies baseline areas of risk andreports them to senior staff

✦ Uses protocols and policies to guidepractice

✦ Honest

✦ Aware

✦ Enquiring

✦ Responsible

✦ Observant

Competency area: quality assurance

quality assurance: Level 1The staff member contributes to the organisation’s quality assurance programme.

quality assurance: Level 2The staff member uses the processes of clinical governance and quality assurance to maintain and improve clinical

practice.


10

quality assurance: Level 3The staff member uses their advanced knowledge to ensure that the organisation’s quality assurance programme is

maintained and developed.

quality assurance: Level 4The staff member ensures that objectives, which have been agreed through a collaborative process, are achieved for

individuals and populations. To this end, competent practitioners apply current, valid professional knowledge and

ethical principles.


✦ Understands the professional andethical issues surrounding decision-making, in both general terms andrelated specifically to palliative care

✦ Knows the principles of research andevidence-based practice

✦ Utilises resources effectively andefficiently

✦ Contributes fully to the process andoutcome of clinical audit

✦ Facilitates the risk assessment process

✦ Critically analyses and develops safepractice through policy development

✦ Initiates significant event analysis

✦ Innovative

✦ Creative


✦ Knows how to lead and developclinical governance and qualityassurance programmes, specificallywithin specialist palliative care

✦ Aware of developments in policy andstrategic initiatives at local, regionaland national levels, particularly relatedto specialist palliative care

✦ Acts as a resource on differentapproaches to quality specialistpalliative care service provision

✦ Effectively uses audit and outcomes toinfluence practice at every strategiclevel

✦ Critically evaluates own and others’performance, through reflection andanalysis

✦ Seeks opportunities to lead andsupport quality initiatives at local,regional and national levels

✦ Demonstrates robust resourcemanagement

✦ Actively involved in business planning

✦ Influential

✦ Assertive

✦ Visionary

✦ Demonstratesclarity


11


✦ Understands the principles of nursingand palliative care practice

✦ Aware of how symptoms andconditions may affect a patient’s well-being

✦ Understands the requirements forreporting on care

✦ Undertakes nursing care, withindefined guidelines and protocols

✦ Assesses patient’s and carer’s needsand recognises the need to report tothe supervising nurse

✦ Collects information that informsnursing care

✦ Involves and promotes the well-beingof the patient and carer

✦ Communicative

✦ Empathetic

✦ A team player

✦ Self-aware

✦ Responsible


✦ Knows about the principles andpractice of palliative and specialistnursing care and symptom control

✦ Understands the psychological issuesand family dynamics affectingterminally ill people and their carers,and integrates this into practice

✦ Recognises the need formultidisciplinary teamwork inpalliative and specialist care

✦ Holistically assesses psychological,cultural, social, legal, and ethical issuesaffecting the patient and their carer’swell-being, care and treatment

✦ Applies appropriate clinical judgement,in consultation with others, to providenursing care that meets the complexityof the patient’s illness

✦ Understands the wide-rangingimplications of the decision-making ofcare and treatment on the patient andcarer

✦ Evaluates outcomes of care and makesalterations appropriate to the ever-changing clinical situation.

✦ Interprets basic clinical data to informdecision-making

✦ Understanding

✦ Responsive

✦ Confident

Competency area: clinical practice, job knowledge and skill

Clinical practice, job knowledge and skill: Level 1The staff member practices holistic nursing care, with supervision, and understands the principles of palliative care.

Clinical practice, job knowledge and skill: Level 2The staff member uses a broad knowledge of the principles of palliative and holistic care, while nursing within the

specialist area. They apply clinical judgement and act interdependently with senior staff.


12

Clinical practice, job knowledge and skill: Level 3The staff member uses extensive knowledge and skills to ensure patients with advanced disease receive comprehensiveevidence-based nursing care. They understand and recognise the impact of advanced disease when interpreting theclinical situation, applying judgement and evaluating the outcomes of care and intervention. They advise and liaise withothers, acting as a resource to support others to achieve effective clinical outcomes.


✦ Uses their knowledge of advancedillness, palliative care and oncology toinform a comprehensive assessment ofthe patient’s needs

✦ Understands the implications ofcomplex clinical issues

✦ Understands the principles ofinformed and independent decision-making

✦ Knows about legal, ethical andprofessional nursing issues - such asinformed choice, consent andempowerment - in relation to nursingpractice

✦ Critically assesses clinical situationsand interprets complex information

✦ Applies professional judgement to makedecisions and achieve appropriate careoutcomes

✦ Develops empowering and facilitativerelationship with patients and carers toinvolve them in decision-making

✦ Acts as a prime resource in providingadvice, information and support tojunior and other staff

✦ Applies knowledge of researchprinciples and best practice to nursingcare

✦ Identifies ideas and strategies thatcontribute to the development of carestandards and processes

✦ A role model

✦ Enquiring

✦ Innovative

✦ Dynamic


✦ Uses their expertise in the principlesand practices of specialist palliativecare and advanced nursing practice

✦ Knows about developing therapeuticrelationships with patients and theircarers to assist their informed choicesfor care and treatment

✦ Understands the immediate and long-term impact and outcomes ofdecisions for patients and carers

✦ Uses research and audit to determineevidence of best practice as a rationalefor prescribed care

✦ Critically analyses complex clinicaldata and information to informdiagnosis and decision-making

✦ Practices independently, seeking todetermine positive outcomes forpatients

✦ Develops detailed standards, protocolsand care strategies in specialistpalliative nursing care

✦ Influences others throughdissemination of knowledge andinformation

✦ Contributes fully to audit of clinicalpractice

✦ Actively seeks new knowledgeinnovations and creates appropriatechange

✦ Influential

✦ A leader

✦ A change agent

✦ A researcher

✦ Empowering

✦ Visionary

Clinical practice, job knowledge and skill: Level 4The staff member applies advanced knowledge in specialist palliative nursing and utilises their experience and skill toperform the role of an expert nurse, educator, researcher, innovator and manager of change. They demonstrateleadership in influencing specialist nursing practice.


13


✦ Knows how to access journal andlibrary resources

✦ Appreciates the need for patients andcarers to have access to informationthat enables informed choice

✦ Aware of the basic educational needsof staff within specialist palliative care

✦ Provides general information topatients, carers and other professionals

✦ Understands specialist palliative carematerial that is aimed at level onecarers

✦ Accesses educational and developmentopportunities

✦ Communicative

✦ Interested

✦ Sensitive

✦ Compliant


✦ Aware of how to contribute to creatinga positive learning environment

✦ Aware of different learning theoriesand their application

✦ Utilises both formal and informalteaching methods

✦ Uses creative and reflective skills withother colleagues

✦ Confident

✦ Self-aware

✦ Facilitative

✦ Knowledgeable


✦ Utilises in-depth knowledge ofspecialist palliative care and the way inwhich adults learn

✦ Knows about effective coaching andmentoring skills

✦ Articulates and reflects palliative careskills, enabling others to learn

✦ Facilitates and develops practicethrough clinical supervision

✦ Appreciates and refers to evidence tosupport practice

✦ Creates a positive learningenvironment

✦ Uses a range of teaching methodsapplicable to various situations

✦ Articulate

✦ Supportive

✦ Reflective

Competency area: education

The staff member understands the importance of knowledge and learning to maintaining standards in specialist

palliative care.

education: Level 1

The staff member understands how adults learn and recognises the need to empower patients, carers and others

through information and education.

education: Level 2

The staff member uses various teaching methodologies to improve outcomes for patients, carers, colleagues and other

professionals. They are able to study and teach at an advanced level.

education: Level 3


14

The staff member is a skilled educator, who is aware of new learning initiatives and issues and is able to advise,

facilitate and deliver post basic education to nurses and other professionals. They are able to contribute to future

learning strategies within specialist palliative care.

education: Level 4


✦ Utilises well-developed academic andspecialist palliative care skills to teachadults in a range of situations

✦ Takes account of factors that mayinhibit individual learning aboutspecialist palliative care

✦ Utilises a variety of differentapproaches to education

✦ Consistently draws on research andliterature to influence specialist andadvanced nursing practice

✦ Reflects upon and learns from ownpractice

✦ Creative

✦ Enquiring

✦ Motivating

✦ Empowering

✦ Innovative


15

Competency area: management and leadership

management and leadership: Level 1The staff member is aware of the organisational philosophy and objectives and uses them to guide practice at all times.


✦ Understands the philosophy of theteam

✦ Aware of the need to support andprovide mentorship to a new teammember

✦ Understands the roles of themultidisciplinary team

✦ Aware of their role, responsibilities andlimitations

✦ Communicates effectively with seniorstaff who take responsibility forpatients and carers

✦ Identifies and reports relevantinformation and observations

✦ Responds to the needs of individualpatients and carers

✦ Contributes to multidisciplinary teammeetings

✦ Develops an awareness of ownstrengths and weaknesses and canidentify their impact on patient care

✦ Aware

✦ Reflective

✦ Considerate

✦ Responsible


✦ Understands the hospice or unit’s clinicalgovernance policy

✦ Recognises the importance of co-ordinating all aspects of the clinical area,including personnel

✦ Understands the importance ofproviding a specialist resource tointernal and external agencies

✦ Recognises the need for continuingprofessional development

✦ Describes the practical impact of clinicalgovernance on patient care with thehospice

✦ Plans and organises effectively and isable to delegate

✦ Creates a clinical environment that isconducive to staff support, learning andcommunication

✦ Understands the organisation’scomplaints policy and what to do if thereis an adverse incident involving patients,staff or drugs

✦ Provides relevant information andmakes appropriate referrals

✦ Reviews and critiques current specialistpalliative care educational material

✦ Identifies own boundaries and learningneeds

✦ Disseminates information on thespecialty in the clinical area

✦ Is conversant with the concept ofreflective practice

✦ Understands the personal performancereview and development process

✦ Articulate

✦ Motivated

✦ Assertive

✦ Demonstratesintegrity

✦ Fair

management and leadership: Level 2The staff member applies knowledge of principles of specialist palliative care and the processes of quality assuranceand risk management.


16

management and leadership: Level 3The staff member uses advanced knowledge and practice to manage their own clinical area and contribute to the overall

management of the hospice or service.


✦ Has a working knowledge ofmanagerial and organisational theory,in order to provide leadership that issensitive to the specialist palliativecare environment

✦ Knows about change management anddecision-making processes

✦ Understands the need to manageresources, within budgetaryconstraints

✦ Supports junior staff to develop skillsin organising, prioritising anddelegating

✦ Ensures an appropriate induction ordevelopment programme is in place

✦ Demonstrates effective management ofall complaints and incidents

✦ Identifies and manages poorperformance

✦ Participates in the unit’s recognisedrole in providing specialist advice andsupport

✦ Utilises resources effectively,organising appropriate cover for aclinical area that recognises the needsof specialist palliative care

✦ Develops individual learning outcomesfor clinicians

✦ Innovative

✦ Sensitive

✦ Enquiring

✦ Confident


✦ Understands advanced nursingpractice, specifically specialistpalliative nursing

✦ Is politically aware of the issuesaffecting the development of specialistpalliative care

✦ Has sound knowledge of changemanagement theory and practice

✦ Knows how to establish the strategicdirection of the service

✦ Reviews and negotiates resources toenhance practice

✦ Uses audit, evaluation and research toinfluence practice at local, regional andnational levels

✦ Identifies areas and producesproposals for service development

✦ Uses networking and influencing skillsto ensure the voice of the specialty isheard

✦ Collates and uses health data to informpolicy and health care practice

✦ Self-assured

✦ Facilitative

✦ Inspirational

management and leadership: Level 4The staff member consistently enhances and develops the provision of specialist palliative care at all levels and settings.


17


✦ Knows the principles of evidence-based practice

✦ Knows the clinical governance agenda

✦ Aware of the constraints andchallenges associated with the limitedresearch for palliative care practice

✦ Delivers competent palliative care,giving a rationale for decisions that isbased on the available evidence

✦ Critically evaluates and reflects onpractice that is founded upon clinicalguidelines and protocols

✦ Promotes discussion and contributesto the development of clinicalguidelines and protocols

✦ Seeks opportunities for clinicalsupervision to enhance the ability toreflect and improve upon practice


✦ Motivated

✦ Interdependent

✦ Confident


✦ Understands agreed guidelines andprotocols

✦ Knows the underlying principles for arange of basic tasks

✦ Aware of the rationale for careplanning and the appropriateoutcomes of daily living activities forpatients requiring specialist palliativecare

✦ Delivers a standard of care in accordwith agreed guidelines and protocols

✦ Contributes to the identification ofareas for development, within thespecialist practice area

✦ Compliant

✦ Participative

✦ Adaptable

Competency area: research and development

research and development: Level 1The staff member understands the importance of using research and development in practice.

research and development: Level 2The staff member takes an active part in discussion groups to identify research that will lead to clinically effective practice.


18

research and development: Level 3The staff member identifies potential research and development questions, participating in research under supervision.They act as a facilitator for change, disseminating research results in specialist palliative care. They participate in practicedevelopment, taking account of organisational and ethical challenges that are pertinent to specialist palliative care.

research and development: Level 4The staff member is exemplary in the delivery of evidence-based practice, promoting an environment where enquiryis valued as a means to improve practice.


✦ Knows about the research process andof the challenges of outcomeorientated research methodology in apalliative care setting

✦ Understands the implications,limitations and ethical dilemmas thatmay arise from the nature of palliativecare research

✦ Consistently refers to research findingsto support practice decisions

✦ Uses well developed reflective skills toevaluate current practice

✦ Collects data from a range of sourcesto inform and shape own ideas

✦ Identifies sources to keep up-to-datewith evidence-based practice

✦ Critically analyses research findingsand literature.

✦ Facilitates discussion on palliative careresearch and evidence-based practice

✦ Influential

✦ Demonstratesinitiative

✦ Solution-orientated


✦ Understands methods to disseminateresearch findings

✦ Leads research, evaluating results tospearhead changes in practice

✦ Acts as a role model in the integrationof evidence-based practice in palliativecare, across a multidisciplinaryperspective

✦ Uses leadership supervisory andfacilitation skills to promote awarenessof research

✦ Proactively disseminates andimplements research findings

✦ Contributes to both regional andnational agendas to improve theevidence base for specialist palliativecare

✦ Creative

✦ Achievementorientated

✦ Capable of makingan impact

✦ Tenacious


19


✦ Understands the key aspects of thegrieving process

✦ Understands the needs of grievingpeople

✦ Knows when to refer to anothermember of the team

✦ Aware of the practicalities of dealingwith death and dying

✦ Supports and listens to grieving people

✦ Gives advice to families and carers onpractical issues following death

✦ Reports accurately to senior staff

✦ Completes relevant documentation

✦ Empathetic

✦ Sensitive

✦ Patient

✦ Non-judgemental


✦ Recognises the needs of grievingpeople and acts appropriately

✦ Understands the theory of the grievingprocess

✦ Uses supportive listening skills to helppeople adjust to their grief

✦ Responds to the needs of theindividual who is bereaved, bringingassurance about the grief process

✦ Respects an individual’s beliefs,community, culture and religion

✦ Confident

Competency area: grief, loss and bereavement

grief, loss and bereavement: Level 1The staff member provides basic support to families and carers.

Level 2The staff member has comprehensive understanding of the grieving process.


20

Level 3The staff member has comprehensive understanding of the grieving process in relation to specialist palliative care.


✦ Knows how to distinguish betweennormal and abnormal grief

✦ Understands the boundaries ofsupport offered

✦ Uses advanced counselling skills tosupport and empower patients andcarers experiencing loss

✦ Refers appropriately to other agenciesand services

✦ Assesses any risks associated with theindividual needs of the bereavedperson

✦ Encourages reflective practice tovalidate and, where possible, improveupon current practice

✦ Assured

Level 4The staff member supports those who have been bereaved using their specialist understanding, including identifying

abnormal manifestations of grief and loss. They act as a supervisor and mentor for staff who offer bereavement support


✦ Has in-depth knowledge of thetheories of grief, loss and bereavement

✦ Has a sound understanding ofabnormal grief reactions

✦ Has comprehensive knowledge ofbereavement services

✦ Advises the bereaved person on futurecare options

✦ Acts as a resource for those providingbereavement care

✦ Collects relevant data to monitoroutcomes of bereavement care

✦ Facilitative

✦ Responsive

Competencies in nursing

December 2002

Published by the Royal College of Nursing 20 Cavendish SquareLondon W1G 0RN

020 7409 3333

The RCN represents nurses and nursing,promotes excellence in practice and shapeshealth policies.

Publication code 001 958

a framework for palliative care - cancerni.net care competencies rcn project.pdf · a framework for...

Documents