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Caring for people with liver disease: a competence framework for nursing

Revised edition

RCN CompetencesRCN Competences

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Acknowledgements

Members of the Specialist Nurses External Reference Group

As part of the National Liver Disease Strategy, a Specialist Nurses External Reference Group was created to undertake various projects.

Helen Caldwell, Nurse Consultant in Hepatology, Royal Liverpool University Hospital, Liverpool

Michelle Clayton, Lecturer in Liver Care, University of Leeds and Liver Recipient Transplant Coordinator, St James’s University Hospital, Leeds

Amanda Clements, Hepatology Nurse Consultant, South West Liver Unit Derriford Hospital, Plymouth

Sandra Crompton, Liver Nurse Practitioner, Bolton NHS Foundation Trust

Elizabeth Farrington, Advanced Nurse Practitioner Hepatology, Royal Cornwall Hospital, Truro

Vicki Finlay, Professional Officer, Department of Health, Quarry House Leeds

Lynda Greenslade, Clinical Nurse Specialist in Hepatology, Royal Free Hospital NHS Foundation Trust, London

Richard Hall, Support Group Co-ordinator, British Liver Trust

Helen Hampton, Primary Care Hepatitis Nurse Specialist, Cornwall NHS

Anne Moger, Nurse Adviser, Department of Health, Wellington House, London

Debbie Morton, Alcohol CNS, Liverpool PCT, Liverpool

Lynn Owens, Nurse Consultant, Liverpool PCT, Liverpool

Ray Poll, Nurse Consultant in Viral Hepatitis, Royal Hallamshire Hospital, Sheffield

Mushi Rahman, Liver Disease Team, Department of Health, Wellington House, London

Sam Readhead, Viral Hepatitis Specialist Nurse, Frimley Park Hospital, Surrey

Norgine Pharmaceuticals Ltd have provided financial support by way of sponsorship for the production and distribution of this framework. Norgine Pharmaceuticals Ltd

had no editorial input into the content of this framework other than a review for medical accuracy.

Reviewers

British Association for the Study of the Liver

British Association for the Study of the Liver Nursing Forum

British Liver Nurses Forum

British Liver Trust

British Society of Gastroenterology

Children’s Liver Disease Foundation

The Hepatitis C Trust

RCN (general consultation)

Liver4Life

To provide feedback contact:

Michelle Clayton [email protected]

Lynda Greenslade [email protected]

[email protected]

We would like to take this opportunity to thank Dr Kim Manley for her invaluable input, support and advice in the development of this framework.

Our thanks also go to the many liver nursing colleagues and other health care professionals (too many to mention individually), that contributed to the development of the framework through generously sharing their thoughts and ideas during its creation. And finally we would like to thank Lynda Greenslade and Michelle Clayton of the Specialist Nurses External Reference Group for their hard work in bringing together the completed Caring for people with liver disease: a competence framework for nursing (revised edition).

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

RCN Competences: Caring for people with liver disease: a competence framework for nursing

Foreword 4

Key stakeholders 5

1. Introduction to the framework 5

2. Context for developing the framework 7

3. What is a competence framework? 8

4. The aim of Caring for people with liver disease: a competence framework for nursing and its relationship to the RCN career and competence and other relevant frameworks 9

5. Using Caring for people with liver disease: a competence framework for nursing 12

6 How to produce evidence to demonstrate competence 15

7. Overview of the competence framework 16

8. Detailed definition of Caring for people with liver disease: a competence framework for nursing 17

9. Quality assurance of the framework 19

10. Caring for people with liver disease: a competence framework for nursing 19

Appendix 1: Nurse Census of roles 62

Appendix 2: Examples of evidence to meet Caring for people with liver disease: a competence framework for nursing 63

Appendix 3: Blank competence sheet to produce own evidence for the Caring for people with liver disease: a competence framework for nursing 67

Appendix 4: References 69

Appendix 5: Useful contacts 70

Appendix 6: The six Cs and how they fit into Caring for people with liver disease: a competence framework for nursing 71

Contents

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R C N C O M P E T E N C E S – C A R I N G F O R P E O P L E W I T H L I V E R D I S E A S E

Foreword

Delivery of high quality care that produces better outcomes for patients needs a high quality workforce: skilled and competent practitioners who are fit to deliver care in the future health and social care system.

Patients and carers have told us that they want to be able to access safe and effective care when they need it and in the right place, delivered by the right person. They want to be empowered to ensure that they exercise maximum choice and control over the services they receive, working in partnership with professionals – ‘no decision without me’.

In conjunction with the Royal College of Nursing (RCN), we have developed a competence framework that describes the knowledge, skills and attitudes that are required to deliver patient-centred liver care. The work has been supported by a range of key stakeholders including professional representatives from the British Society of Gastroenterology (BSG), British Liver Trust (BLT), The Hepatitis C Trust, British Association for the Study of the Liver Nurses Forum (BASLNF) and the British Liver Nurses Forum (BLNF). Competence frameworks are focused on outcomes and are an indispensible tool for those commissioning, managing and developing the workforce. They inform the development of education and training programmes as well as assessment strategies.

I commend this framework to you and hope that you use it to develop the workforce so that the quality and efficiency of services provided for people at risk of or with a diagnosis of liver disease are improved across the liver care spectrum, from prevention and early identification through to end of life.

Professor Martin Lombard National Clinical Director National Liver Disease Strategy

The ethos of Caring for people with liver disease: a competence framework for nursing has been to develop a set of competences that all nurses can use regardless of their area of clinical practice. The framework will help to equip the nurse to identify individuals at risk of liver disease, promote healthy livers and lifestyle as well as care for individuals with existing liver disease. Liver disease is increasing and the full impact has not yet been felt; it was once a minority killer, however liver disease is now becoming commonplace and is the fifth biggest killer in the United Kingdom. Age is no barrier to liver disease and, as such, raising awareness of risk factors across the age spectrum is essential. There is a great need to reverse this growing problem and the promotion of a healthy liver as a way of life to this generation and the next is a key concept.

Nurses are integral to making an impact on liver disease; nurses can make every contact count by identifying risk factors for the three major types of liver disease – alcohol, hepatitis B and C and obesity leading to non-alcoholic fatty liver disease (NAFLD); and by offering health promotion and education to help individuals to make informed choices. Some nurses will also need to be able to offer care to patients with existing liver disease and this competence framework has also been devised to support quality standards for care. Liver patients can be challenging and can have a complexity that requires nurses to draw upon multiple skills and talents. I hope that this publication will equip a nurse with the required skills and knowledge base to help make a difference for the individual with, or at risk, of liver disease by the delivery of effective quality care. Caring for people with liver disease: a competence framework for nursing aims to turn a little known and thought of disease into an everyday thought, which will help to encourage identification and prevention of liver disease development.

All nurses – regardless of clinical background – have the skills and talents to integrate liver health into the health care arena as a healthy liver is essential in maintaining a healthy life.

Michelle Clayton RGN, MSc, PGC in Clinical Education, BSc (Hons), Steering committee member, RCN Gastrointestinal Nursing Forum, Chair of the Specialist Nurses External Reference Group, National Liver Disease Strategy

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Key stakeholders

Introduction to the framework

This competence framework describes the professional standards expected of practitioners when caring for people with liver disease – adults and young people – across England.

Liver disease is now the fifth most common cause of death in the United Kingdom (Williams et al, 2014). What was once thought to be a rare disease is emerging to be a major killer and its prevalence has risen exponentially year on year in recent times, see Table 1. There are three major culprits that have led to this incredible rise: alcohol, viral hepatitis and obesity leading to non-alcoholic fatty liver disease (NAFLD). These three areas are essentially preventable causes and have been attributed to changes in lifestyle. One of the challenges in caring for patients is to raise awareness amongst all health care professionals in primary and secondary care as well as the general public. Public attention surrounding liver disease is not always positive due to its links to health inequalities and also the stigmatisation of this disease being as ‘self-inflicted’.

Table 1: England – liver disease mortality trend dramatic increase relative to other major disease groups.WHO/Europe, European HFA Database, January 2012

1

300

250

200

150

100

50

0

-50

-100

Movements in mortality 1971-2007

Deaths per million of population

% c

hang

e vs

197

1

1971

Year

Road

1981 1991 2001 2007

Liver Diabetes Cancer Respiratory Heart Stroke

Liver4Life

6


of Health, England and the Royal College of Nursing, Gastrointestinal Nurses Forum.

The framework focuses on the general needs of people with liver disease and is intended to be used with other local policies and pathways around the scope of practice undertaken by nurses working at all levels.

Caring for people with liver disease: a competence framework for nursing is an essential document for all nurses whatever their clinical background and setting. The document has been produced to provide a framework on which skills, knowledge and understanding can be assessed. A recent survey of nurses from the RCN Gastrointestinal Nurses forum, British Liver Nurses’ Forum and British Association for the Study of Liver Disease Nurses Forum (2015) felt that the framework helped liver nurses plan their appraisals, identify development needs in their role, develop new roles and help to upskill ward teams. The competence framework should be seen as a flexible document that allows individual liver nurses to utilise those competences that are specific to them and does not have to be undertaken as a whole. It is important to recognise that the competence levels do not translate to agenda for change banding and a nurse’s competence level may vary in different competences.

The competence document may also be useful for those health care professionals (HCPs) i.e. GPs, social workers,dietitians and drug and alcohol workers who are also working with patients with or at risk of liver disease in primary or secondary care and may be useful as part of their professional learning and development. The document can also be used by student nurses to improve their knowledge, understanding and skill acquisition of caring for people with or at risk of liver disease. See page 9.

Nurses are key to the prevention of liver disease. Nurses in every area of clinical practice can identify individuals at risk of liver disease, for example, screening for hepatitis B and C, alcohol consumption and obesity, and help them to make informed choices through health promotion and education. The role of brief advice is a key component, whether in primary, secondary or tertiary care, and identification of risk factors, verbal and written information and signposting to support services can be invaluable in helping to reducing the risk of liver disease. Having a healthy liver should be just as important as a healthy heart, bones or teeth. Tackling obesity is already high on the public health agenda with campaigns to encourage and empower patients to make healthier choices in relation to eating, exercise and weight management (NICE, 2014). Some causes of liver disease, for example hepatitis B and C, are now highly treatable and can prevent liver disease from developing if detected early enough and individuals are referred for treatment (NICE, 2012). Whether in primary or secondary care, nurses who care for individuals with such conditions as diabetes and metabolic syndrome can also help to promote a healthy liver.

Age is no barrier to liver disease and as such, raising awareness of risk factors in the form of health education and promotion from an early age should be encouraged i.e. obesity in children and safe limits for drinking alcohol in the older population. This is an extremely important public health role as there is a great need to reverse the growing problem that we have and to promote a healthy liver as a way of life to the next generation. Established liver disease is generally life-limiting and the treatment options available, such as liver transplantation, is a limited resource. In England and Wales there was a 25 per cent increase in liver deaths between 2001 and 2009 (National End of Life Care Intelligence Network, 2012). Liver patients are known to die younger than the general population and the majority die in a hospital setting (NCEPOD, 2013). This is the opposite of most major disease processes where dying in hospital is in the minority. Therefore end of life planning and subsequent care delivery is another important area in which nurses in both primary and secondary care settings have a key role.

The National Liver Disease Strategy for England identified, with expert nurses working within the specialty, the need for a framework to ensure patients with liver diseases or risk factors to the disease were recognised. This document encapsulates the requirements and professional standards which will help nurses aspire to providing quality liver care and improving outcomes. This was a a joint development between a selected group of liver nurses on behalf of the Department

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The National Liver Disease Strategy for England (Department of Health, unpublished at present) aimed to transform the way health and social care services supported people with liver disease to deliver optimum outcomes. Those with liver disease would be identified earlier, diagnosed with improved accuracy and receive treatment that is equitable, responsive, high-quality and effective with the overall aim of reducing premature mortality associated with liver disease. This should be from the right person, at the right time, in the right place, within evidence-based standards of care and treatment, ensuring dignity and respect are at the heart of the patient journey. It aimed to ensure that all communities had appropriate prevention strategies for liver disease that include improved partnership working to address major lifestyle drivers and programmes to identify those most at risk. Further work has been undertaken by the Lancet Commission for Liver Disease (Williams et al, 2014) which has made recommendations to address the premature mortality and health inequalities that exist for people with or at risk of liver disease.

The NHS is judged on its performance in reducing deaths from liver disease through the NHS Outcomes Framework. Everyone in the NHS – and many outside it – have their part to play in making this happen. Through the NHS Outcomes Framework, the NHS Commissioning Board is held to account by the Secretary of State for making improvements to quality and outcomes in the public’s health. The NHS Commissioning Board hold Clinical Commissioning Groups to account on the services they commission for their local populations. The services, treatment and care provided to those with liver disease is a vital part of this.

Public Health England is also judged on the contribution it makes to reducing the number of people developing liver disease and reducing deaths from liver disease, through the Public Health Outcomes Framework. All health care professionals working within the NHS – both in primary and secondary care – can help to contribute to improvements in the public’s health, not just by treating those who already have liver disease, but also by helping to prevent it developing in those at risk.

In recognising the significant burden of liver disease, it is essential to ensure that a workforce is competent and confident to deliver high quality services to patients with a diagnosis of, or at risk, of developing liver disease is coherently developed. Williams et al (2014) has made a number of recommendations on a robust and coherent workforce and appropriate hospital services to care for people with liver disease.

A national census of nurses specialising in the care of people with liver disease (see appendix 1) was undertaken in late 2012, this was recognised to be a snapshot. As a growing specialty it is recognised that the demographics of this workforce will be constantly changing and adapting to the change in liver disease provision. However, this piece of work helped to identify areas that liver nurses work in and the diversity of nurses working in liver services.

Nurses who work in the arena of liver disease are at present a disparate group and encompass expertise in a wide range of disease processes, from the more common areas of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease (NAFLD) to those who cover general hepatology including autoimmune hepatitis, haemochromatosis and hepatocellular carcinoma. The Lancet Commission (Williams et al, 2014) recognises the important contribution that liver nurses play but has identified that there is a need for further access to liver specific education. There is also a small group of specialised nurses that care for patients pre- and post-liver transplant.

Currently there is no umbrella organisation specifically for liver nurses, and this mirrors the medical profession who also do not have a single organisation. Some liver nurses are affiliated with either the British Association for the Study of the Liver Nurse Forum (BASLNF) or the British Liver Nurses Forum (BLNF). The RCN Gastrointestinal Nurses Forum also has a role representing nurses who care for people with liver disease.

The competence framework was commissioned around key areas highlighted by this group to complement the RCN core career and competence framework (RCN, 2009). The Department of Health commissioned Dr Kim Manley, formally of the Royal College of Nursing, who has a wide interest in the development of person-centred care to develop Caring for people with liver disease: a competence framework for nursing. Once the key areas were identified, Dr Manley developed the framework which was then reviewed by the Specialist Nurses External Reference Group to develop the liver context. A UK-wide consultation with a wide range of stakeholder groups and experts enabled completion of this competence framework. This revised edition of this framework was undertaken by the RCN Gastrointestinal Nurses forum who commissioned a survey to gather nurses’ views and experience of using the framework to guide amendments and changes in this revised edition.

Context for developing the framework

2

8


What is a competence framework?

3

For the purpose of this document competence can be defined as:

“The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one’s professional responsibilities (Roach, 1992)”.

Competences are the essential building blocks that shape nursing work in all clinical and practice settings. As practitioners acquire skills, knowledge, understanding and confidence in their field of liver practice they are able to demonstrate how they meet increasingly challenging levels of competence.

This document provides a resource for all grades of staff to enable learning and development around promoting healthy livers and lifestyles.

The framework aims to identify the competences required to meet the specific needs of people with liver disease, as well as provide support to registered nurses, health care assistants and assistant practitioners wishing to grow their expertise and progress their career in caring for this client group.

The competence framework is presented across bands 1-8 of the Skills for Health career framework and therefore provides both a competence and career framework for those wishing to specialise in the care of people with liver disease.

The competences are written from an outcome approach to competence, making clear the actions and activities expected in the workplace. This is in common with the NHS Knowledge and Skills Framework (KSF) against which the specific competences are also mapped

The Skills for Health career framework uses similar language and terminology to the NHS job evaluation (JE) scheme but they have different levels and meanings:

“The two systems are not interchangeable and the career framework should only be used to create career pathways for staff working in the NHS. The JE Scheme should only be used to measure the demands of jobs in order to give them a banding within the NHS pay scale.”

(NHS Employers, 2011)

Appendix 6 on page 71 demonstrates NHS England’s six Cs and how they fit into Caring for people with liver disease: a competence framework for nursing.

The framework aims to integrate high quality liver care for all individuals and their family/ carers. This care will be person-centred and encompassing the core values of the six Cs.

The RCN Principles of Nursing Practice can be aligned to the six Cs as a UK framework for delivering safe and effective nursing care.

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The aim of this framework and its relationship to the RCN career and competence and other relevant frameworks

4

This publication aims to complement and not duplicate the RCN’s Integrated core career and competence framework for registered nurses publication which outlines what is expected of registered practitioners of nursing across all client groups and specialities (RCN, 2009). The RCN’s Integrated core career and competence framework for registered nurses identifies the competences required for achieving person-centred, safe and effective care by registered nurses, drawing on those KSF dimensions of particular relevance to nursing rather than other members of the health care team.

Through not duplicating general competences common to all client groups and settings, Caring for people with liver disease: a competence framework for nursing enables the unique aspects of the specialty to be accentuated for learning and development purposes as well as for making clear expectations of each level of the career pathway.

For this reason, in depth competences around using evidence-based practice, research, quality improvement, learning and development and leadership are not included as this would be duplication.

Other relevant frameworks include:

l RCN Principles of Nursing Practice (2010) which identify what the public can expect of nursing regardless of who in the nursing team is the most immediate provider of care. They have been developed with patient and user groups across the UK and identify eight overarching principles

l NICE guidelines, interventional procedures and appraisals in relation to people with liver disease (see www.nice.co.uk website for a wide range of guidance on liver conditions). Evidence-based guidelines and standards continue to be developed and refined and provide the most up-to-date and appraised evidence base to inform specific interventions. Relevant guidelines are identified in the context of the competence framework.

The competence framework, although making reference to highly specialised interventions such as liver transplantation and end of life care pathways, does not identify detailed performance indicators in relation to these areas. Instead the focus is on making clear what is expected in terms of professional standards for the vast majority of people experiencing liver disease.

The competence levels in this document were originally aligned to the career trajectory of Benner’s From novice to expert (1982). Health care assistants (HCAs) are at the first level of the career trajectory which equates to levels 1, 2, 3 and 4 of the career framework for health (Skills for Health, 2005).

Levels 1-4 can also be used by student nurses to help improve their knowledge, understanding and skill acquisition in caring for people with, or at risk, of liver disease.

Registered practitioner/competent nurse (level 5 of the career framework for health)This level defines the entry point for registered nurses to the specialty of liver disease or registered nurses working in other environments that encounter people with, or at risk of, liver disease. At this level, the registered practitioner caring for the patient with liver disease or individual at risk of liver disease will be developing expertise to undertake assessment and management of patients. They will demonstrate working knowledge of the key specialist treatments and interventions appropriate to this group. Generally, these nurses work on a regular, but not necessarily full-time, basis with people who have or are at risk of liver disease.

With experience, the nurse’s interpersonal skills develop so that they can initiate discussions on the impact of liver disease on personal relationships and daily living activities. They will learn when and how to refer patients directly to other health care professionals, such as dietitians, drug and alcohol services and social workers.

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Levels 1-4 Non-registered practitioner: this level could relate to health care assistants or student nurses working in a drug or alcohol environment, on a gastroenterology ward or liver unit, with liver outpatients or related to hepatobiliary conditions.

Level 5 Registered practitioner: this level could encompass any registered nurse who cares for a patient with liver disease or risk factors for liver disease in primary or secondary care and could relate to any clinical background or setting.

Level 6 Senior practitioner: this level could encompass nurses within drug and alcohol services, viral hepatitis, nurses with experience of caring for liver patients over a number of years, junior ward sister level or newly appointed specialist nurse.

Level 7 Advanced level practitioner: this level could encompass the experienced clinical nurse specialist, ward manager, practice development nurse and liver recipient transplant co-ordinator.

Level 8 Consultant practitioner: this level could encompass a nurse who may have developed or is leading a service, for example, nurse consultant in viral hepatitis or lead nurse for hepatology.

Experienced/proficient nurse (level 6 of the career framework for health)At this level the registered practitioner in the liver service will have developed expertise to use detailed theoretical and practical knowledge in liver management. Some knowledge will involve a critical understanding of theories, principles and pathophysiology. The practitioner will be able to demonstrate mastery of methods and tools in complex care, and demonstrate innovation in terms of methods used while having the ability to devise and sustain arguments to solve problems.

Senior registered practitioner (level 7 of the career framework for health)Often regarded as specialist, or advanced practice or for those in a managerial role, this is the extension and expansion of the registered practitioner role. Liver nurses practising at this level of clinical practice work according to local protocols to co-ordinate the comprehensive care of patients, who could equally be cared for by doctors. These nurses can work autonomously without asking the advice of a doctor. Any nurse working at this level is required to work within the boundaries of their own knowledge and competence, and refer to or seek advice/opinions from medical colleagues for cases beyond their clinical expertise. Selected treatments will expand some nursing roles such as supporting patients through treatment for hepatitis C, and continuity of care through independent prescribing.

The expected workload of senior registered practitioners differs between settings, depending on local need, resources and infrastructure. This may include specialist nurses roles and also nurses managing patients in secondary care or primary care settings.

Consultant practitioner (level 8 of the career framework for health)Previously defined as higher level of practice, this level may reflect the role of the nurse consultant but not always. Nurses working at this level have been employed to satisfy the individual needs of the service in which they are located. All posts need to conform to a common core of expectations outlined by the NHS Executive, which are:

l expert practice

l professional leadership and consultancy

l education, training and development

l practice and service development, research and evaluation.

Taken from Skills for Health (2005) Career Framework for Health.

For each of the competences, the performance indicators, knowledge, understanding and practical know-how are identified for levels 1-8 of the clinical career framework. Each level of the identified performance, knowledge, understanding, practical know-how and attitudes and behaviours builds on the previous level of expectations. Further discussion on these indicators can be found in section five of this document and section six gives examples of what evidence to collect. The framework recognises that there is a need for a range of competences in every team as well as a range of practitioners operating at different levels.

The clinical career framework levels used within this competence framework do not reflect the Agenda for Change banding levels.

Therefore a staff nurse at band 5 (Agenda for Change) who has worked within the area of liver disease for a number of years may have varying levels of competence either at level 5, 6 or 7 within different competences.

For example, for competence 7.2: nutrition and fluid management/hydration in patients with liver disease, the staff nurse may achieve level 6 as they have worked with liver patients for a number of years and can fulfil the performance and knowledge and understanding criteria.

Within this document, levels of competence are as follows:Table 2: The levels of competence and examples of roles

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Whereas a practice nurse may be a band 7 (Agenda for Change), but may achieve a level 5 in competence 5 (develops and evaluates a self-management plan with the patient who has predisposing factors to liver disease) as the practice nurse may have a broad understanding of chronic diseases but not in-depth liver disease knowledge.

The competence framework is designed to allow nurses from many clinical backgrounds to tailor their development of competence in working with patients with varying degrees of liver health. This can be achieved by nurses (in conjunction with their manager) being able to choose some or all of the relevant competences to demonstrate development of key skills, knowledge and understanding for this patient group. Successful demonstration of competence can be used as evidence of meeting professional development needs.

Practitioners will always need to be aware of local guidelines and protocols as well as working within the scope of professional practice when initiating treatment and interventions. Liver disease management is a dynamic and rapidly changing professional arena, therefore all health care professionals need to remain up-to-date and utilise contemporary evidence-based practice.

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Using Caring for people with liver disease: a competence framework for nursing

5

The framework is intended to support the learning and development needs of staff and health care organisations as well as enable career progression and role clarity, making clear the professional standards expected for patients and service users.

Caring for people with liver disease: a competence framework for nursing includes a number of examples of how to use a competence in practice. The examples relate to different liver nursing roles such as senior staff nurse/junior sister, practice nurse, specialist nurse – see Appendix 2 (p. 63) onwards.

These are intended only as a guide in order to achieve an individual competence. There will be many other examples of liver nursing care that could be used as evidence to achieve the competence.

It would be envisaged that some of the competences could be shared across a team of nurses working at the desired level; this may be used to support quality standards for care. The competence framework may be individually tailored to a specific liver nursing role. This may assist in the development of innovative liver nursing roles in the future.

It is not envisaged that all nurses working in primary and secondary care will need to meet all of the competences. Caring for people with liver disease: a competence framework for nursing has been developed to allow nurses to select relevant competences to their role and scope of practise. However as nurses progress through the career trajectory, there should be emphasis on attainment of all the levels and all relevant competences that complement the higher role and scope of practice.

Organisations should be encouraged to use the framework to help identify any competence gaps in service provision. Individuals and teams should use it as a developmental framework both collectively and individually. Higher Education Institutes may draw on the framework for curriculum development. Commissioners of both services and education may also find this framework a useful tool.

With all competence documents there is specific terminology used. In relation to Caring for people with liver disease: a competence framework for nursing the following headings in table 3 are used.

Competence Identifying the specific aspect of care.

Level The levels used relate to Skills for Health career framework. Nurses using this document may be at different levels for different competences.

KSF Demonstrates the skills cross-referenced to dimensions with the knowledge and skills framework.

Performance criteria

Describes the skills required for each competence. In order to achieve a higher level, the individual will have had to demonstrate achievement at the previous level for performance, knowledge and understanding, knows how to and attitudes and behaviours.

Knowledge and

understanding

Describes specific areas that are pertinent to the competence.

Knows how to Describes the tacit knowledge required in each competence.

Attitudes and behaviours

Each level has a number of required attitudes and behaviours to support the individual’s competence development.

Contextual factors

Each competence contains a list of generic and specific resources.

It is important to recognise that each level is integral to the next and as such individuals need to demonstrate progression by achieving each level before moving on to the next.

Each competence is designed as a building block to develop performance, knowledge, understanding, attitudes and behaviours from a fundamental level through to specialist and/or advanced practice. As such each of these areas link together in order to build the individual’s competence and contribute to their professional development.

In relation to individual competence, the performance indicators help to identify the actions that would establish whether the competence is met but are also intended to be used flexibly in reviewing competence as they may be influenced by the context. The knowledge and understanding, as well as, the practical know-how required to achieve the performance indicators are identified in relation to each competence.

Table 3: Definitions of the terminology used in the framework

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How to implement the framework into practice

The framework is a flexible document that can be utilised in all areas working with people with, or at risk of, of liver disease. Sections of the framework can be selected to complete rather than undertaking the whole document. You and your team should identify the relevant competences to your area and then identify the levels of competence that you and your staff wish to achieve. One tip would be to start small and build over time.

The framework could be embedded into the ward or team philosophy and can be used to identify learning needs for individuals or the team. It can also become part of the personal development plan/appraisal process where areas of competence can be identified to complement learning and development. The framework can be used to identify gaps in service provision.

In light of the new revalidation process for nurses and midwives to practise (Nursing and Midwifery Council, 2015) this framework will help you to achieve some of the requirements identified. For example, demonstrating up-to-date practice and professional development and reflecting on professional standards of practice and behaviors.

This framework can be used by those working within a clinical team including on wards, outpatients, ITU, endoscopy, A&E or as an individual. A suggested format for implementation is set out below.

Assess

• Identify key members of the team across all bands.

• Review competence framework and identify appropriate levels of competence for each band (see Table 2, page 10).

• Choose one competence to pilot over a number of different levels.

• Publicise what you are doing and how this will help your area of clinical practice.

• Consider how to embed into the ward/team philosophy.

Plan

• Identify training needs that arise from the chosen competence.

• Identify an appropriate timeframe.

• Preparation of materials for ward/individuals that will meet NMC requirements for portfolio, for example download the document and reproduce the chosen competence.

• Consider what evidence is needed and how will it be assessed.

Implement

• Working with identified mentor/practice educator/supervisor/ward sister etc.

• Collect, demonstrate and/or show evidence for each competence identified.

• Ensure that evidence which shows the competence has been met is signed and dated and kept by the ward/individual

Evaluate

• Meeting with mentor/practice educator/supervisor/ward sister to review progress and evidence collected.

• Identify any gaps in learning.

• Competence can be used to complement PDP/appraisal processes.

• Reflect on the process. Consider sustainability and use of a yearly audit to review progress.

Examples in Practice

Example 1

As part of the trust alcohol team you work in A&E delivering brief interventions. As part of raising awareness about alcohol and the use of brief advice you want to roll out the Alcohol Use Disorders Identification Test (AUDIT) tool in your trust. You target A&E and your assessment unit to start and start training sessions:

Teaching includes what the AUDIT score means:

risk category AUDIT score

Abstainer 0

Lower risk 1-7

Increasing risk 8-15

Higher risk 16-19

Possible dependence

20-40

Adapted from Barbor et al, 2001

Assessment of competence would entail using a combination of methods, for example, self-assessment, observation of practice, structured reflection, peer review, document audit and clinical supervision. These methods are practice development tools that assist individuals and teams to achieve continuous development. However, developing a portfolio of multiple sources of evidence against competence standards may also be used to support both academic and professional accreditation.

14


Teaching reveals an increase in AUDIT scoring by 76 per cent and this is improves again at six months to 81 per cent. This results in more referrals to the alcohol team and a reduction in A&E referrals by GPs.

This would fit competence 2. (signposts and supports patients (families and carers) in their understanding of their condition through patient education and health promotion) the evidence produced would be able to be used to support levels five and six.

Example 2

You manage a nursing team on a busy GI ward with a large liver population and you have a large number of new staff who are new to caring for patients with liver disease. This is a good opportunity to implement the competence framework. You put together a working group of ward staff from different bands to look at how to implement the framework.

As a team you identify what is expected from a:

• health care assistant

• band five staff nurse

• band six

• band seven ward manager

Once the competences required are identified your team can start delivering teaching on the competences.

You may not need all of them and in this example you could use competence 3 (undertakes a comprehensive clinical assessment including risk profiling and follows up with appropriate action, including referral to specialists, for relevant acute and chronic health care conditions) as well as competence 7 (provides specific diagnostic / treatment options safely). You will have identified at what level you will expect each member of the team to achieve and demonstrate in your planning. Both competences include specific nursing care that would include managing:

• a variceal bleed

• a jaundiced patient

• a patient who is malnourished

• a patient with ascites

This identifies the learning needs (identifying and managing the complications of chronic liver disease). Once education has been delivered then the nurse can start to develop the skills, knowledge and understanding needed to demonstrate competence and attain the appropriate evidence.

Evidence sheets can be found in Appendix 3 (p. 67)

15


How to produce evidence to demonstrate competence

6

You are responsible for developing your own portfolio of evidence for each competence in order to demonstrate that you have achieved it at the identified/desirable level.

How to produce evidence to demonstrate competenceForms of evidence that you can use include case histories, self-appraisal via a reflective diary, 360-degree feedback, verification of practice and structured observation of practice. So, when you gather evidence it is important to consider the following:

l ensure that you understand what the competence statement is asking of you

l review any existing work that could be used

l identify whether the existing evidence is appropriate

l consider what else you may need to do in developing evidence; for example, are you familiar with a reflective model?

Will someone be giving you feedback on your practice? Do you have further development needs and have you considered how you might address them? Think about using evidence that covers several competences; for example, one case study may demonstrate that you have used a variety of knowledge and skills in treating a patient and in this instance you should be able to triangulate evidence against several competences.

For example, if you attend a study day in preparation for carrying out a particular intervention but you have not practised the skill in a clinical setting, your certificate of attendance is not evidence of competence and you will have to consider making arrangements for supervised practice. However, if you have undergone training and have evidence of supervised practice and use new knowledge and skills on a regular basis the evidence should be enough, consider what else you may need to do in developing evidence, such as feedback on your practice; if you have further development needs, are they recorded in a personal development plan?

How do I get started?You will need to look at the competence statements, and decide where you fit on the career trajectory in terms of development and what you already do. Table 2 may help you to clarify where you fit in the career trajectory.

What is evidence?There is a variety of material that you can collect to capture evidence of competence. This may include:

l evidence of supervised practice such as signed observation of undertaking a procedure

l projects

l practice developments/changes in practice

l critical incidents

l assessments and appraisals

l publications and presentations

l audits

l teaching packages

l posters

l certificates of attendance with reflections on learning

l evidence of group work

l policy and protocol development

l evidence of membership of advisory groups

l research and evidence-based reviews

l witness statements, when focused and well structured.

The strength of the competence framework lends itself to the assessment of nursing practice at a local level in partnership with multidisciplinary colleagues. However, assessment may also take place through higher education university courses, and formal examination. Practitioners who carry out the assessments should have adequate expertise and training in the assessment and mentoring process, together with a higher level knowledge of aesthetic practice.

See Appendix 2 (p. 63) for examples of how to use evidence to support attainment of the competence.

16


Overview of the competence framework

7

Caring for people with liver disease: a competence framework for nursing is structured around nine competences. These are not placed in any hierarchal order as they are interdependent. However, they do start with a person-centred approach where there is a high regard for the person with liver disease as someone with expertise about themselves; then move through the assessment, intervention and evaluation processes; concluding with a key nursing function – care pathway co-ordination and management.

The nine liver care competences are:

1. Provides empathy and understanding and works with the patient (and their family/carers) particularly those with chronic liver disease as experts in their own condition.

2. Signposts and supports patients (and family/carers) in their understanding of their condition through patient education and health promotion.

3. Undertakes a comprehensive clinical assessment including risk profiling and follows up with appropriate action, including referral to specialists, for relevant acute and chronic health care conditions.

4. Assesses, in collaboration with the patient (young people, adults, family/carers), their health care needs, taking into account the impact of their age, vulnerability, their lifestyle, cultural and ethnic background.

5. Develops and evaluates a self-management plan with the patient who has predisposing factors to liver disease.

6. Works alongside and with the patient (and families/carers) to address the psychological and social impact of their condition.

7. Provides specific diagnostic/treatment options safely:

7.1. undertaking phlebotomy and cannulation in the patient with difficult access associated with their liver disease

7.2. nutrition and fluid management/hydration in patients with liver disease

7.3. pharmacological treatment and side-effects

7.4. non-invasive diagnostics and treatment options

7.5. invasive diagnostics and treatment options.

8. Uses early warning tools/approaches to identify the patient’s changing and deteriorating condition, and takes appropriate action.

9. Actively improves and promotes liver services across the appropriate care pathway.

17


Detailed definition of Caring for people with liver disease: a competence framework for nursing

8

Competence 1

Provides empathy and understanding and works with the patient (and their family/carers) particularly those with chronic liver disease as experts in their own condition.

This competence will assist the liver nurse in developing understanding, knowledge and person-centred care for the individual with liver disease. To acknowledge the role of the liver patient as an expert in their own condition and to foster partnership working.

Competence 2

Signposts and supports patients (and families/carers) in their understanding of their condition through patient education and health promotion.

This competence embraces the wide spectrum of causes of liver disease and works with patients and their carers to support and develop understanding of risk factors or the individual’s existing liver disease.

Competence 3

Undertakes a comprehensive clinical assessment including risk profiling and follows up with appropriate action, including referral to specialists, for relevant acute and chronic health care conditions.

This competence helps to develop the knowledge and skills required to identify changes in liver health status and develop understanding of liver pathophysiology linked to the individual’s liver disease process.

Competence 4

Assesses, in collaboration with the patient (young people, adults, family/carers), their health care needs, taking into account the impact of their age, vulnerability, their lifestyle, cultural and ethnic background.

This competence recognises the diversity of individuals with liver disease and considers the impact of a range of factors including cultural, ethnic background and life choices on their liver condition.

Competence 5

Develops and evaluates a self-management plan with the patient who has predisposing factors to liver disease.

This competence encourages close partnership working with the individual with predisposing factors to liver disease, to empower them to make choices in managing their changing liver health.

Competence 6

Works alongside and with the patient (and families/carers) to address the psychological and social impact of their condition.

This competence addresses the wide spectrum of psychological and social impacts that individuals and their families/carers may have to deal with in relation to their liver disease.

18


Competence 7

Provides specific diagnostic/treatment options safely: this competence embraces a range of therapeutic interventions that some patients with liver disease may experience during their care.

7.1 Undertaking phlebotomy and cannulation in the patient with difficult access associated with their liver disease. This competence considers a range of strategies to enable successful phlebotomy or cannulation in the difficult to access individual with liver disease.

7.2 Nutrition and fluid management/hydration in patients with liver disease. This competence will assist a nurse to demonstrate an in-depth knowledge and understanding of the role of nutrition and its importance in liver disease.

7.3 Pharmacological treatment and side-effects. This competence addresses the complexity of medication in individuals with liver disease and it recognises the contribution of the nurse as a non-medical prescriber.

7.4 Non-invasive diagnostics and treatment options. This competence introduces a broad range of non invasive liver specific investigations and the role of the liver nurse to support the patient at this time.

7.5 Invasive diagnostics and treatment options. This competence introduces a broad range of invasive diagnostics and treatment options and the role of the nurse to support the patient through the diagnostic journey.

Competence 8

Uses early warning tools/approaches to identify the patient’s changing and deteriorating condition, and takes appropriate action.

This competence alerts the nurse to early warning tools used for general deterioration and raises awareness of specific issues in relation to the deteriorating liver patient.

Competence 9

Actively improves and promotes liver services across the appropriate care pathway.

This competence is designed to support development and/or improvement of liver services in both primary and/or secondary care.

19

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

Quality assurance of the framework

9

As with all information and evidence, more becomes available daily. It is therefore vital that this framework is periodically reviewed and updated – a criterion of all good accreditation processes. An annual risk assessment will enable any risks to be identified and a cycle of document review will ensure it continues to be relevant to nurses caring for people with liver disease in a changing context. This will be undertaken by the RCN Gastrointestinal Nurses Forum.

Caring for people with liver disease: a competence framework for nursing

10

20


Leve

lCo

mpe

tenc

eK

SF

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form

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cri

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fact

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di

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of t

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terd

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de a

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to e

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at th

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of

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ents

and

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par

ticu

larl

y th

ose

who

are

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nera

ble

due

to

thei

r con

diti

on, t

heir

nee

ds a

nd

view

s ar

e he

ard

and

acte

d on

.

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e N

ursi

ng a

nd M

idw

ifery

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ncil

(NM

C)

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sing

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e of

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duct

• lo

cal p

roto

cols

, sta

ndar

ds a

nd

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es fo

r pat

ient

car

e in

rela

tion

to

acu

te a

nd c

hron

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ver d

isea

se,

incl

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g tr

eatm

ent

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e di

ffer

ence

s be

twee

n ac

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and

chro

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dis

ease

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ow

n un

ders

tand

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of th

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pact

of c

o-m

orbi

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essi

on

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rinci

ples

of t

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t pat

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loso

phy

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le a

nd c

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ibut

ions

of e

ach

mem

ber

of th

e in

terd

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plin

ary

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.

Kno

ws

how

to:

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e re

spon

sive

to p

atie

nt fe

edba

ck a

nd

addr

ess

conc

erns

app

ropr

iate

ly.

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e of

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lim

itat

ions

.

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ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

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to id

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fy

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ning

nee

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ntab

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artn

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rtiv

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and

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n an

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arn

from

ow

n pr

acti

ce.

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lexi

ble.

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on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

21


1-4

Prov

ides

em

path

y an

d un

ders

tand

ing

and

wor

ks

with

the

patie

nt (a

nd

thei

r fam

ily/

care

rs) a

nd

part

icul

arly

th

ose

with

ch

roni

c liv

er

dise

ase

as

expe

rts

in th

eir

own

cond

ition

.

Core

1

Core

6

HW

B1

HW

B3

HW

B4

a. A

sks

ques

tion

s an

d ac

tive

ly

liste

ns.

b. E

stab

lishe

s th

e pa

tien

t’s

pref

eren

ces

and

boun

dari

es fo

r sh

arin

g pe

rson

al h

ealt

h in

form

atio

n,

for e

xam

ple

prot

ecti

ng th

eir p

riva

cy

and

confi

dent

ialit

y.

c. P

erso

nalis

es c

are.

d. R

espe

cts

and

ackn

owle

dges

a

pati

ent o

r fam

ily m

embe

r/ca

rer a

s an

exp

ert i

n th

eir o

wn

cond

itio

n,

part

icul

arly

if th

ey h

ave

chro

nic

liv

er d

isea

se.

e. E

mpa

this

es w

ith

and

is re

spon

sive

to

the

need

s of

pat

ient

s w

ith

acut

e an

d ch

roni

c liv

er d

isea

se.

f. R

ecog

nise

s th

at p

atie

nts

wit

h ch

roni

c liv

er d

isea

se m

ay

have

men

tal h

ealt

h is

sues

and

ch

ange

s in

moo

d du

e to

hep

atic

en

ceph

alop

athy

or f

or e

xam

ple

Wer

nick

e’s/

Kor

sako

ff’s

psy

chos

is/

alco

hol w

ithd

raw

al.

• t

he P

rinc

iple

s of

nur

sing

pra

ctic

e

• t

he D

epar

tmen

t of H

ealt

h (D

H) g

uida

nce

on th

e Ex

pert

Pat

ient

• t

he c

halle

nges

pos

ed w

hen

cari

ng fo

r pe

ople

wit

h ch

roni

c liv

er d

isea

se a

nd

the

impa

ct o

n th

e fa

mily

/car

er

• t

he im

pact

of h

epat

ic e

ncep

halo

path

y on

men

tal h

ealt

h, m

ood,

per

sona

lity,

m

emor

y an

d un

ders

tand

ing

of th

eir

dise

ase.

• A

war

e of

role

lim

itat

ions

and

w

hen

to o

btai

n he

lp.

• P

erso

n ce

ntre

d an

d co

mpa

ssio

nate

.

• L

iste

ns.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• C

onfid

enti

al.

• P

ride

in w

ork.

• R

espe

ctfu

l.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gui

danc

e.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f life

car

e.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2)

Dea

ths

from

Liv

er D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S.

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as, C

QU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a re

view

of p

atie

nts

who

die

d w

ith

alco

hol-r

elat

ed li

ver d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fir

st

24 h

ours

• N

HS

Engl

and

(201

3) T

he 6

Cs

5Pr

ovid

es

empa

thy

and

unde

rsta

ndin

g an

d w

orks

w

ith th

e pa

tient

(and

th

eir f

amily

/ ca

rers

) and

pa

rtic

ular

ly

thos

e w

ith

chro

nic

liver

di

seas

e as

ex

pert

s in

thei

r ow

n co

nditi

on.

Core

1

Core

6

HW

B1

HW

B3

HW

B4

HW

B5

HW

B6

a. D

iscu

sses

car

e/tr

eatm

ent o

ptio

ns

and

offe

rs c

hoic

es to

reac

h jo

int a

nd

info

rmed

dec

isio

n m

akin

g.

b. C

o-de

velo

ps, i

mpl

emen

ts a

nd

eval

uate

s pe

rson

al c

are

plan

s,

trea

ting

the

pati

ent a

s an

indi

vidu

al.

c. E

ncou

rage

s fe

edba

ck fr

om th

e pa

tien

t, th

eir f

amily

and

car

ers.

d. W

orks

col

labo

rati

vely

wit

h ot

her

mem

bers

of t

he in

terd

isci

plin

ary

team

to p

rovi

de a

sea

mle

ss s

ervi

ce.

e. A

cts

to e

nsur

e th

at th

e vo

ice

of

pati

ents

and

car

ers,

par

ticu

larl

y th

ose

who

are

vul

nera

ble

due

to

thei

r con

diti

on, t

heir

nee

ds a

nd

view

s ar

e he

ard

and

acte

d on

.

• th

e N

ursi

ng a

nd M

idw

ifery

Cou

ncil

(NM

C)

Nur

sing

Cod

e of

Con

duct

• lo

cal p

roto

cols

, sta

ndar

ds a

nd

guid

elin

es fo

r pat

ient

car

e in

rela

tion

to

acu

te a

nd c

hron

ic li

ver d

isea

se,

incl

udin

g tr

eatm

ent

• th

e di

ffer

ence

s be

twee

n ac

ute

and

chro

nic

liver

dis

ease

• p

atie

nts’

ow

n un

ders

tand

ing

of th

e im

pact

of c

o-m

orbi

diti

es o

n th

emse

lves

e.

g. a

lcoh

ol a

nd o

besi

ty to

geth

er, v

iral

he

pati

tis

and

alco

hol u

se; a

lcoh

ol

and

depr

essi

on

• p

rinci

ples

of t

he e

xper

t pat

ient

phi

loso

phy

• ro

le a

nd c

ontr

ibut

ions

of e

ach

mem

ber

of th

e in

terd

isci

plin

ary

team

.

Kno

ws

how

to:

• b

e re

spon

sive

to p

atie

nt fe

edba

ck a

nd

addr

ess

conc

erns

app

ropr

iate

ly.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• S

uppo

rtiv

e.

• E

ncou

ragi

ng.

• Em

pow

erin

g.

• P

rovi

des

choi

ces.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

Pro

vide

s em

path

y an

d un

ders

tand

ing

and

wor

ks w

ith

the

pati

ent (

and

thei

r fa

mil

y/ca

rers

) and

par

ticu

larl

y th

ose

wit

h ch

roni

c li

ver

dise

ase

as e

xper

ts in

thei

r ow

n co

ndit

ion

(con

tinu

ed)

1 Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

6Pr

ovid

es

empa

thy

and

unde

rsta

ndin

g an

d w

orks

w

ith th

e pa

tient

(and

th

eir f

amily

/ ca

rers

) and

pa

rtic

ular

ly

thos

e w

ith

chro

nic

liver

di

seas

e as

ex

pert

s in

thei

r ow

n co

nditi

on.

Core

1

Core

6

HW

B1

HW

B3

HW

B4

HW

B5

HW

B6

a. S

uppo

rts

team

mem

bers

to c

o-de

velo

p,

impl

emen

t and

eva

luat

e pe

rson

al c

are

plan

s.

b. A

cts

as a

role

mod

el to

ens

ure

that

team

m

embe

rs e

nabl

e th

e pa

tien

ts’ v

oice

to b

e he

ard

and

acte

d on

.

• ad

voca

cy n

eeds

for t

hose

who

are

less

abl

e to

ac

t for

them

selv

es d

ue to

thei

r liv

er c

ondi

tion

le

adin

g to

cha

lleng

ing

beha

viou

r, d

epre

ssio

n or

in

abili

ty to

art

icul

ate

thei

r nee

ds d

ue to

hep

atic

en

ceph

alop

athy

or o

ther

cog

niti

ve im

pair

men

t

• ac

ute

and

long

-ter

m c

ompl

icat

ions

rela

ted

to

liver

dis

ease

• st

rate

gies

pat

ient

s ca

n us

e fo

r man

agin

g co

-mor

bidi

ties

• lo

cal a

nd n

atio

nal s

trat

egy

for p

atie

nts

wit

h liv

er

dise

ase

and

how

to c

ontr

ibut

e

• Pa

tien

t Rep

orte

d O

utco

me

Mea

sure

s

(PR

OM

S) a

nd P

atie

nt R

epor

ted

Expe

rien

ce

Mea

sure

s (P

REM

S).

Kno

ws

how

to:

• bu

ild a

nd fo

ster

an

equi

tabl

e

nurs

e-pa

tien

t rel

atio

nshi

p

• w

ork

wit

h pa

tien

ts w

ith

chal

leng

ing

beha

viou

r an

d co

llabo

rati

vely

dev

elop

car

e pl

ans

• di

ffus

e an

ger a

nd c

halle

ngin

g be

havi

our

• de

velo

p ca

re p

lans

in c

onju

ncti

on w

ith

lo

cal g

uide

lines

.

• M

odel

s be

st p

ract

ice.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pat

ient

s.

• Ch

alle

nges

oth

ers.

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Spec

ific

• D

H (2

001)

Exp

ert P

atie

nt.

• Pa

tien

t Saf

ety

Firs

t cam

paig

n.

• N

atio

nal o

ccup

atio

nal s

tand

ards

for

heal

th a

nd s

ocia

l car

e

HSC

31 a

nd H

SC35

.

7Pr

ovid

es

empa

thy

and

unde

rsta

ndin

g an

d w

orks

w

ith th

e pa

tient

(and

th

eir f

amily

/ ca

rers

) and

pa

rtic

ular

ly

thos

e w

ith

chro

nic

liver

di

seas

e as

ex

pert

s in

thei

r ow

n co

nditi

on.

Core

1

Core

6

HW

B1

HW

B3

HW

B4

HW

B5

HW

B6

a. If

app

ropr

iate

, inv

ites

the

pati

ent t

o sh

are

thei

r exp

erie

nce

as a

reso

urce

for t

each

ing

nurs

es a

nd o

ther

s.

b. D

evel

ops

pati

ent p

athw

ays

in c

olla

bora

tion

w

ith

pati

ents

and

use

r gro

ups.

c. O

vers

ees

and

mon

itor

s th

e qu

alit

y of

car

e.

• lo

cal u

ser n

etw

orks

and

teac

hing

opp

ortu

niti

es

• cl

inic

al in

dica

tors

• re

leva

nt N

HS

polic

ies.

• R

ole

mod

el.

• Pr

ovid

es s

tron

g le

ader

ship

.

• Ch

alle

nges

ass

umpt

ions

and

ta

ken

for g

rant

ed w

ays

of

wor

king

.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

es.

22


Sig

npos

ts a

nd s

uppo

rts

pati

ents

(an

d fa

mil

ies/

care

rs) i

n th

eir

unde

rsta

ndin

g of

thei

r co

ndit

ion

thro

ugh

pati

ent e

duca

tion

and

he

alth

pro

mot

ion

2 Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

1-4

Sign

post

s pa

tient

s (a

nd

fam

ilies

/ ca

rers

) to

info

rmat

ion

abou

t the

ir

cond

ition

.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. S

ignp

osts

pat

ient

s, fa

mili

es

and

care

rs to

furt

her i

nfor

mat

ion

and

orga

nisa

tion

s.

• ra

nge

of a

ppro

ved

info

rmat

ion

sour

ces

avai

labl

e in

loca

l are

a

• o

rgan

isat

ions

and

age

ncie

s pr

ovid

ing

supp

ort

• w

hen

to a

lert

regi

ster

ed n

urse

s ab

out

info

rmat

ion

requ

este

d an

d pr

ovid

ed to

en

able

follo

w th

roug

h.

Kno

ws

how

to:

• a

cces

s fu

rthe

r sup

plie

s

• re

cogn

ise

own

boun

dari

es, c

ompe

tenc

e an

d re

spon

sibi

lity.

• A

war

e of

role

lim

itat

ions

and

w

hen

to o

btai

n he

lp.

• P

erso

n ce

ntre

d an

d co

mpa

ssio

nate

.

• L

iste

ns.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• C

onfid

enti

al.

• P

ride

in w

ork.

• R

espe

ctfu

l.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er

Nur

ses

Foru

m (B

ASL

NF)

.

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f life

car

e.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om L

iver

Dis

ease

. Im

plic

atio

ns fo

r en

d of

life

car

e.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le

peop

le in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as, C

QU

INS,

PR

OM

S et

c.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a re

view

of

pat

ient

s w

ho d

ied

wit

h al

coho

l-rel

ated

live

r di

seas

e, L

ondo

n, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fi

rst 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

5Si

gnpo

sts

and

supp

orts

pa

tient

s (a

nd

fam

ilies

/ ca

rers

) in

thei

r un

ders

tand

ing

of th

eir

cond

ition

th

roug

h pa

tient

ed

ucat

ion

and

heal

th

prom

otio

n.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. A

sses

ses

know

ledg

e an

d un

ders

tand

ing

of p

atie

nt’s

and

ca

rer’

s ow

n co

ndit

ion,

cau

ses,

ri

sk fa

ctor

s an

d co

nseq

uenc

es.

b. P

rovi

des

tailo

red

educ

atio

n to

pat

ient

and

fam

ily/c

arer

s on

co

ndit

ion,

trea

tmen

ts a

nd s

ide-

effe

cts.

c. P

rovi

des

info

rmat

ion

abou

t lif

esty

le fa

ctor

s, c

onse

quen

ces

and

serv

ices

ava

ilabl

e to

sup

port

lif

esty

le c

hang

es.

d. R

efer

to o

ther

app

ropr

iate

he

alth

car

e pr

ofes

sion

als

if

requ

ired

.

• ri

sk fa

ctor

s, s

uch

as, d

rugs

, obe

sity

, alc

ohol

• in

form

atio

n, s

uch

as, D

H D

rink

wis

e, e

duca

tion

an

d su

ppor

t res

ourc

es, s

ervi

ces

and

spec

ialis

t st

aff a

vaila

ble

• d

iffer

ent c

omm

unic

atio

n an

d en

gage

men

t ap

proa

ches

to p

rovi

ding

edu

cati

on

and

info

rmat

ion

• h

ealt

h pr

omot

ion,

sex

ual h

ealt

h st

rate

gies

and

e-

lear

ning

reso

urce

s av

aila

ble,

suc

h as

from

the

PHE

Alc

ohol

Lea

rnin

g R

esou

rces

• p

osit

ive

lifes

tyle

app

roac

hes

and

advi

ce

• h

ow to

giv

e br

ief a

dvic

e an

d in

terv

enti

ons

for

pati

ents

wit

h al

coho

l mis

use,

con

tinu

ed IV

DU

use

an

d w

eigh

t man

agem

ent.

Kno

ws

how

to:

• ta

ilor i

nfor

mat

ion

and

educ

atio

n to

the

pers

on

• o

btai

n ed

ucat

iona

l inf

orm

atio

n or

dir

ect p

atie

nts/

fam

ilies

/car

ers t

o av

aila

ble

reso

urce

s, se

rvic

es a

nd

staf

f, in

clud

ing

the

volu

ntar

y se

ctor

• w

ork

wit

hin

thei

r lev

el o

f com

pete

nce.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• E

mpa

thet

ic.

• E

ncou

ragi

ng.

• S

uppo

rtiv

e.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

23


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

1-4

Sign

post

s pa

tient

s (a

nd

fam

ilies

/ ca

rers

) to

info

rmat

ion

abou

t the

ir

cond

ition

.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. S

ignp

osts

pat

ient

s, fa

mili

es

and

care

rs to

furt

her i

nfor

mat

ion

and

orga

nisa

tion

s.

• ra

nge

of a

ppro

ved

info

rmat

ion

sour

ces

avai

labl

e in

loca

l are

a

• o

rgan

isat

ions

and

age

ncie

s pr

ovid

ing

supp

ort

• w

hen

to a

lert

regi

ster

ed n

urse

s ab

out

info

rmat

ion

requ

este

d an

d pr

ovid

ed to

en

able

follo

w th

roug

h.

Kno

ws

how

to:

• a

cces

s fu

rthe

r sup

plie

s

• re

cogn

ise

own

boun

dari

es, c

ompe

tenc

e an

d re

spon

sibi

lity.

• A

war

e of

role

lim

itat

ions

and

w

hen

to o

btai

n he

lp.

• P

erso

n ce

ntre

d an

d co

mpa

ssio

nate

.

• L

iste

ns.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• C

onfid

enti

al.

• P

ride

in w

ork.

• R

espe

ctfu

l.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er

Nur

ses

Foru

m (B

ASL

NF)

.

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f life

car

e.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om L

iver

Dis

ease

. Im

plic

atio

ns fo

r en

d of

life

car

e.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le

peop

le in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as, C

QU

INS,

PR

OM

S et

c.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a re

view

of

pat

ient

s w

ho d

ied

wit

h al

coho

l-rel

ated

live

r di

seas

e, L

ondo

n, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fi

rst 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

5Si

gnpo

sts

and

supp

orts

pa

tient

s (a

nd

fam

ilies

/ ca

rers

) in

thei

r un

ders

tand

ing

of th

eir

cond

ition

th

roug

h pa

tient

ed

ucat

ion

and

heal

th

prom

otio

n.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. A

sses

ses

know

ledg

e an

d un

ders

tand

ing

of p

atie

nt’s

and

ca

rer’

s ow

n co

ndit

ion,

cau

ses,

ri

sk fa

ctor

s an

d co

nseq

uenc

es.

b. P

rovi

des

tailo

red

educ

atio

n to

pat

ient

and

fam

ily/c

arer

s on

co

ndit

ion,

trea

tmen

ts a

nd s

ide-

effe

cts.

c. P

rovi

des

info

rmat

ion

abou

t lif

esty

le fa

ctor

s, c

onse

quen

ces

and

serv

ices

ava

ilabl

e to

sup

port

lif

esty

le c

hang

es.

d. R

efer

to o

ther

app

ropr

iate

he

alth

car

e pr

ofes

sion

als

if

requ

ired

.

• ri

sk fa

ctor

s, s

uch

as, d

rugs

, obe

sity

, alc

ohol

• in

form

atio

n, s

uch

as, D

H D

rink

wis

e, e

duca

tion

an

d su

ppor

t res

ourc

es, s

ervi

ces

and

spec

ialis

t st

aff a

vaila

ble

• d

iffer

ent c

omm

unic

atio

n an

d en

gage

men

t ap

proa

ches

to p

rovi

ding

edu

cati

on

and

info

rmat

ion

• h

ealt

h pr

omot

ion,

sex

ual h

ealt

h st

rate

gies

and

e-

lear

ning

reso

urce

s av

aila

ble,

suc

h as

from

the

PHE

Alc

ohol

Lea

rnin

g R

esou

rces

• p

osit

ive

lifes

tyle

app

roac

hes

and

advi

ce

• h

ow to

giv

e br

ief a

dvic

e an

d in

terv

enti

ons

for

pati

ents

wit

h al

coho

l mis

use,

con

tinu

ed IV

DU

use

an

d w

eigh

t man

agem

ent.

Kno

ws

how

to:

• ta

ilor i

nfor

mat

ion

and

educ

atio

n to

the

pers

on

• o

btai

n ed

ucat

iona

l inf

orm

atio

n or

dir

ect p

atie

nts/

fam

ilies

/car

ers t

o av

aila

ble

reso

urce

s, se

rvic

es a

nd

staf

f, in

clud

ing

the

volu

ntar

y se

ctor

• w

ork

wit

hin

thei

r lev

el o

f com

pete

nce.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• E

mpa

thet

ic.

• E

ncou

ragi

ng.

• S

uppo

rtiv

e.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

See

abov

e.Se

e ab

ove.

See

abov

e.Se

e ab

ove.

See

abov

e.•

Key

qual

ity

assu

red

pati

ent a

nd c

arer

in

form

atio

n an

d su

ppor

t fro

m k

ey

char

itie

s an

d or

gani

sati

ons,

suc

h as

: –

Bri

tish

Liv

er T

rust

– Ch

ildre

n’s

Live

r Dis

ease

Fou

ndat

ion

– A

lcoh

ol C

once

rn–

The

Hep

atit

is C

Tru

st–

Hep

atit

is B

Fou

ndat

ion

UK

– H

aem

ochr

omat

osis

Soc

iety

– W

ilson

’s D

isea

se S

uppo

rt

Gro

up (U

K)–

PBC

Foun

dati

on–

Rar

e D

isea

ses

UK

– PS

C Su

ppor

t–

Roy

al c

olle

ges,

suc

h as

, Phy

sici

ans,

G

ener

al P

ract

itio

ners

, Sur

geon

s,

Ana

esth

etis

ts–

Bri

tish

Soc

iety

of G

astr

oent

erol

ogy

(BSG

)–

Bri

tish

Ass

ocia

tion

for t

he S

tudy

of

the

Live

r (B

ASL

)–

Euro

pean

Ass

ocia

tion

for t

he S

tudy

of

the

Live

r (EA

SL)

– A

mer

ican

Ass

ocia

tion

for t

he S

tudy

of

Liv

er D

isea

ses

(AA

SLD

)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Sig

npos

ts a

nd s

uppo

rts

pati

ents

(an

d fa

mil

ies/

care

rs) i

n th

eir

unde

rsta

ndin

g of

thei

r co

ndit

ion

thro

ugh

pati

ent e

duca

tion

and

he

alth

pro

mot

ion

(con

tinu

ed)

2

24


Sig

npos

ts a

nd s

uppo

rts

pati

ents

(an

d fa

mil

ies/

care

rs) i

n th

eir

unde

rsta

ndin

g of

thei

r co

ndit

ion

thro

ugh

pati

ent e

duca

tion

and

hea

lth

prom

otio

n (c

onti

nued

)2 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

6Si

gnpo

sts

and

supp

orts

pa

tient

s (a

nd

fam

ilies

/ ca

rers

) in

thei

r un

ders

tand

ing

of th

eir

cond

ition

th

roug

h pa

tient

ed

ucat

ion

and

heal

th

prom

otio

n.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. R

ecog

nise

s pa

tien

ts in

divi

dual

trea

tmen

t ch

oice

s.

b. S

uppo

rts

pati

ents

sen

siti

vely

and

em

path

etic

ally

whe

n:

– u

nder

goin

g ri

sk p

rofil

ing

– re

ceiv

ing

thei

r res

ults

and

dia

gnos

is, w

hich

m

ay in

clud

e gi

ving

bad

new

s, ta

king

into

ac

coun

t whe

ther

the

pati

ent i

s an

adu

lt o

r a

youn

g pe

rson

.

c. P

rovi

des

cult

ural

ly s

ensi

tive

pat

ient

and

car

er

info

rmat

ion

abou

t con

diti

on, l

ocal

and

nat

iona

l in

form

atio

n, s

uppo

rt g

roup

s an

d ch

arit

ies.

• lo

cal g

uida

nce

and

refe

rral

pat

hway

s

• ad

opti

ng p

osit

ive

lifes

tyle

app

roac

hes

and

mod

ifica

tion

s

• re

quir

emen

ts fo

r goo

d in

form

atio

n st

anda

rds

and

the

qual

ity

assu

ranc

e an

d re

view

pro

cess

es

for p

atie

nt in

form

atio

n do

cum

enta

tion

• he

alth

edu

cati

on s

kills

• kn

owle

dge

of in

form

atio

n so

urce

s –

web

site

s,

leafl

ets,

cha

riti

es, k

ite-

mar

ked

info

rmat

ion

• lo

cal a

nd n

atio

nal c

hari

ties

• de

term

inan

ts o

f hea

lth,

suc

h as

, pov

erty

, cul

ture

, re

ligio

n et

c

• cu

ltur

al a

nd s

ocia

l ris

k fa

ctor

s su

ch a

s Kh

at

chew

ing,

her

bal a

nd C

hine

se m

edic

atio

ns,

spec

ific

nutr

itio

nal s

uppl

emen

ts a

nd o

ther

su

bsta

nces

use

d to

boo

st p

hysi

cal p

erfo

rman

ce

that

may

cau

se li

ver d

isea

se

• ph

arm

acol

ogic

al s

ide

effe

cts

of tr

eatm

ents

.

Kno

ws

how

to:

• re

cogn

ise

and

use

pati

ent/

serv

ice

user

in

form

atio

n th

at is

qua

lity

assu

red

• us

e br

ief i

nter

vent

ions

and

mot

ivat

iona

l in

terv

iew

ing

arou

nd d

rugs

, alc

ohol

, wei

ght

man

agem

ent,

dep

ress

ion

and

liver

dis

ease

• de

velo

p co

llabo

rati

ve a

gree

men

ts a

roun

d co

mm

itm

ent t

o he

alth

rela

ted

beha

viou

rs

• si

gnpo

st s

uppo

rt s

ervi

ces

such

as

Wei

ght

Wat

cher

s, A

lcoh

olic

s A

nony

mou

s, T

he H

epat

itis

C

Trus

t and

oth

ers

• re

fer t

o sp

ecia

list s

ervi

ces.

• Em

pow

erin

g.

• M

odel

s be

st p

ract

ice.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pa

tien

ts.

Spec

ific

• D

rink

wis

e.

• W

eigh

t Wat

cher

s.

• A

lcoh

olic

Ano

nym

ous.

• A

lcoh

ol P

olic

y U

K.

• P

HE

Alc

ohol

Lea

rnin

g R

esou

rces

.

• G

uide

lines

for t

he d

iagn

osis

and

tr

eatm

ent o

f cho

lang

ioca

rcin

oma.

• E

urop

ean

Ass

ocia

tion

for t

he S

tudy

of

The

Liv

er G

uide

lines

Asc

ites

, SB

P,

HE

and

HR

S.

• A

mer

ican

Ass

ocia

tion

for t

he S

tudy

of

Liv

er D

isea

ses,

Gui

delin

es fo

r liv

er

dise

ases

.

• N

ICE

clin

ical

gui

delin

es 1

41 (2

012)

A

cute

upp

er g

astr

oint

esti

nal

blee

ding

: man

agem

ent.

• N

ICE

Gui

danc

e on

Alc

ohol

, Cir

rhos

is

and

NA

FLD

.

25


Sig

npos

ts a

nd s

uppo

rts

pati

ents

(an

d fa

mil

ies/

care

rs) i

n th

eir

unde

rsta

ndin

g of

thei

r co

ndit

ion

thro

ugh

pati

ent e

duca

tion

and

hea

lth

prom

otio

n (c

onti

nued

)2 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7Si

gnpo

sts

and

supp

orts

pa

tient

s (a

nd

fam

ilies

/ ca

rers

) in

thei

r un

ders

tand

ing

of th

eir

cond

ition

th

roug

h pa

tient

ed

ucat

ion

and

heal

th

prom

otio

n.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. In

terp

rets

com

plex

inve

stig

atio

n re

sult

s an

d pr

oced

ures

and

exp

lain

s th

ese

to p

atie

nts.

b. E

nsur

es p

atie

nt (a

nd fa

mily

/car

ers

whe

re re

leva

nt) u

nder

stan

ds ri

sk p

rofil

ing

impl

icat

ions

and

resu

lts,

and

dis

cuss

es o

ptio

ns

avai

labl

e.

c. W

orks

wit

h sp

ecia

lists

incl

udin

g sp

ecia

list

coun

sello

rs, p

allia

tive

car

e ex

pert

s w

here

ap

prop

riat

e.

d. E

nsur

es ti

mel

y re

ferr

al to

oth

er c

linic

al c

are

prov

ider

s w

here

app

ropr

iate

, and

follo

w u

p.

e. C

ontr

ibut

es to

qua

lity

assu

ranc

e an

d ac

cred

itat

ion

proc

esse

s ar

ound

pat

ient

in

form

atio

n.

• ri

sk p

rofil

ing

test

s av

aila

ble,

thei

r im

plic

atio

ns

and

resu

lts

• na

tion

al s

tand

ards

and

loca

l gui

delin

es

• ne

w o

r em

ergi

ng th

erap

ies

• co

mpl

ex tr

eatm

ent g

roup

s, s

uch

as,

co-in

fect

ion,

mul

tipl

e ae

tiol

ogie

s, a

nd

pre-

tran

spla

nt a

nd p

ost t

rans

plan

t iss

ues

• av

aila

ble

reso

urce

s an

d su

ppor

t ser

vice

s lo

cally

, re

gion

ally

and

nat

iona

lly a

nd th

eir a

ccre

dita

tion

an

d qu

alit

y as

sura

nce

proc

esse

s.

Kno

ws

how

to:

• re

fer t

o sp

ecia

list c

ouns

ellin

g an

d pa

lliat

ive

care

se

rvic

es

• qu

alit

y as

sure

and

acc

redi

t pat

ient

info

rmat

ion

liter

atur

e.

• R

ole

mod

el.

• Pr

ovid

es s

tron

g le

ader

ship

.

• Ch

alle

nges

ass

umpt

ions

and

ta

ken

for g

rant

ed w

ays

of w

orki

ng.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

es.

See

abov

e.

26


Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

3 Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cr

iter

iaK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

1-4

Und

erta

kes

nurs

ing

obse

rvat

ions

, re

cord

s ac

cura

tely

an

d re

port

s al

l ch

ange

s.

Core

1

Core

6

HW

B1

HW

B3

HW

B4

HW

B6

a. U

nder

take

s an

d re

cord

s nu

rsin

g ob

serv

atio

ns.

b. M

easu

res

and

reco

rds

wei

ght

accu

rate

ly.

c. T

akes

ap

prop

riat

e ac

tion

in

clud

ing

whe

n re

cord

ings

fall

outs

ide

agre

ed

para

met

ers.

• th

e no

rmal

par

amet

ers

of n

ursi

ng

obse

rvat

ions

for p

atie

nts

wit

h liv

er d

isea

se.

Kno

ws

how

to:

• re

cord

nur

sing

obs

erva

tion

s an

d

take

app

ropr

iate

act

ion/

refe

rral

for

abno

rmal

resu

lts

• th

e im

port

ance

of r

epor

ting

and

reco

rdin

g si

gns

and

sym

ptom

s su

ch a

s na

usea

, vom

iting

, pr

uritu

s an

d al

tere

d m

enta

l sta

te

• re

cogn

ise

dete

rior

atio

n an

d re

port

to

appr

opri

ate

regi

ster

ed p

ract

itio

ner a

nd n

eed

for p

ossi

ble

end

of li

fe c

are.

• A

war

e of

role

lim

itat

ions

and

whe

n to

ob

tain

hel

p.

• Pe

rson

cen

tred

and

com

pass

iona

te.

• Li

sten

s.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• Co

nfide

ntia

l.

• Pr

ide

in w

ork.

• R

espe

ctfu

l.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gui

danc

e.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er N

urse

s Fo

rum

(B

ASL

NF)

.

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f life

car

e.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2)

Dea

ths

from

Liv

er D

isea

se. I

mpl

icat

ions

for e

nd o

f life

car

e.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

th

e re

form

ed N

HS.

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as, C

QU

INS,

PR

OM

S et

c.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al 2

014)

.

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a re

view

of p

atie

nts

who

di

ed w

ith

alco

hol-r

elat

ed li

ver d

isea

se, L

ondo

n, N

CEPO

D.

• N

HS

IQ (

Impr

ovin

g qu

alit

y).

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s).

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3).

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fir

st

24 h

ours

.

• N

HS

Engl

and

(201

3) T

he 6

Cs.

27


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

1-4

See

abov

e.Se

e ab

ove.

See

abov

e.Se

e ab

ove.

See

abov

e.•

Key

qual

ity

assu

red

pati

ent a

nd c

arer

in

form

atio

n an

d su

ppor

t fro

m k

ey

char

itie

s an

d or

gani

sati

ons,

suc

h as

: –

Bri

tish

Liv

er T

rust

– Ch

ildre

n’s

Live

r Dis

ease

Fou

ndat

ion

– A

lcoh

ol C

once

rn–

The

Hep

atit

is C

Tru

st–

Hep

atit

is B

Fou

ndat

ion

UK

– H

aem

ochr

omat

osis

Soc

iety

– W

ilson

’s D

isea

se S

uppo

rt G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

).

• N

HS

Engl

and

The

Info

rmat

ion

Stan

dard

.

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

.

• Sk

ills

for H

ealt

h.

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

(con

tinu

ed)

3

28


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5U

nder

take

s a

com

preh

ensi

ve

phys

ical

as

sess

men

t an

d fo

llow

s up

with

ap

prop

riat

e ac

tion,

in

clud

ing

refe

rral

to

med

ical

sp

ecia

lists

for

rele

vant

acu

te

and

chro

nic

heal

th c

are

cond

ition

s.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. U

nder

take

s an

d re

cord

s nu

rsin

g as

sess

men

t an

d hi

stor

y ta

king

.

b. Id

enti

fies

sign

s of

live

r dis

ease

in s

tool

s,

urin

e an

d sk

in.

c. Id

enti

fies

indi

vidu

als

at ri

sk, s

uch

as, d

rugs

, al

coho

l, ob

esit

y, c

o-m

orbi

diti

es, d

epre

ssio

n.

d. A

sses

ses

nutr

itio

nal s

tatu

s.

e. Id

enti

fies

sign

s an

d sy

mpt

oms

of a

lter

ed

men

tal s

tate

incl

udin

g ce

rebr

al o

edem

a fo

r ac

ute

liver

failu

re.

f. A

cts

on fi

ndin

gs o

f nur

sing

ass

essm

ent.

g. E

xpla

ins

rele

vant

inve

stig

atio

ns to

pat

ient

s an

d se

rvic

e us

ers.

h. U

ses

loca

l gui

delin

es fo

r the

car

e of

peo

ple

wit

h liv

er d

isea

se.

i. U

se o

f inf

ecti

on c

ontr

ol a

nd p

reve

ntio

n po

licie

s w

hen

cari

ng fo

r pat

ient

s.

j. R

efer

s to

app

ropr

iate

spe

cial

ist t

eam

.

k. D

irec

ts th

e pa

tien

t to

spec

ialis

t hel

p.

l. Ca

rrie

s ou

t inv

esti

gati

ons

rela

ted

to ri

sk

profi

ling

unde

r loc

al g

uida

nce.

• fu

ncti

ons

of th

e liv

er

• no

rmal

and

abn

orm

al li

ver a

nato

my

and

phys

iolo

gy

• ch

ange

s to

the

stoo

ls, u

rine

and

ski

n in

live

r di

seas

e e.

g. ja

undi

ce, b

ruis

ing,

scr

atch

mar

ks,

palm

ar e

rthy

ema,

asc

ites

, liv

er fl

ap (a

ster

ixis

)

• so

me

of th

e ef

fect

s of

dru

gs m

etab

olis

ed b

y

the

liver

• ef

fect

of l

iver

dis

ease

on

othe

r bod

y sy

stem

s,

such

as,

men

tal f

unct

ion,

car

diov

ascu

lar a

nd

rena

l fun

ctio

n

• sp

ecifi

c ac

ute

and

chro

nic

com

plic

atio

ns a

nd

thei

r man

agem

ent i

nclu

ding

:

– pr

urit

us

– sk

in ra

shes

as

side

eff

ects

of d

rug

trea

tmen

ts

espe

cial

ly in

rela

tion

to v

iral

hep

atit

is

– hy

pote

nsio

n du

e to

dru

g re

late

d, s

uch

as,

Prop

rano

lol,

and

non-

drug

rela

ted

reas

ons

such

as

deco

mpe

nsat

ed li

ver d

isea

se

– ja

undi

ce

– bi

liary

com

plic

atio

ns, s

uch

as, c

hole

cyst

itis

an

d/or

cho

lang

itis

– po

rtal

hyp

erte

nsio

n an

d oe

soph

agea

l var

ices

– as

cite

s/sp

onta

neou

s ba

cter

ial p

erit

onit

is

– he

pato

rena

l fai

lure

– he

pati

c en

ceph

alop

athy

– ri

sk o

f cer

ebra

l oed

ema

in a

cute

live

r fai

lure

– se

psis

whi

ch o

ften

pre

cipi

tate

s va

rice

al

blee

ding

or h

epat

ic e

ncep

halo

path

y

– ca

rdio

vasc

ular

and

resp

irat

ory

com

plic

atio

ns

– co

agul

opat

hy

– re

cogn

ise

the

sign

s an

d sy

mpt

oms

of a

lcoh

ol

and

/or d

rug

wit

hdra

wal

• al

tere

d pa

thop

hysi

olog

y an

d di

ffere

nt m

anag

emen

t of

dec

ompe

nsat

ed li

ver d

isea

se a

nd a

cute

on

chro

nic

liver

dis

ease

and

thei

r com

plic

atio

ns

• al

tere

d pa

thop

hysi

olog

y in

acu

te li

ver f

ailu

re a

nd

its

man

agem

ent a

nd s

igni

fican

ce o

f det

erio

rati

on

• im

port

ance

of n

utri

tion

in c

hron

ic li

ver d

isea

se

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• Su

ppor

tive

.

• En

cour

agin

g.

• Pr

ovid

es c

hoic

es.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• N

on-ju

dgm

enta

l.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

• St

arts

to d

emon

stra

te a

tten

tion

to

det

ail.

• A

ctiv

e in

ow

n le

arni

ng.

• O

pen

to re

ceiv

ing

feed

back

.

• O

pen

min

ded.

• R

eflec

tive

.

Spec

ific

• Lo

cal p

roto

cols

and

gui

delin

es

• S

tand

ards

for c

linic

al p

ract

ice

and

trai

ning

(joi

nt s

tate

men

ts) f

rom

:

– R

oyal

Col

lege

of A

naes

thet

ists

– R

oyal

Col

lege

of P

hysi

cian

s

– Th

e In

tens

ive

Care

Soc

iety

– Th

e R

esus

cita

tion

Cou

ncil

• N

ICE

Gui

danc

e on

Alc

ohol

• N

ICE

Gui

danc

e on

Liv

er

• N

HS

Blo

od a

nd T

rans

plan

t Pol

icie

s Li

ver T

rans

plan

t: s

elec

tion

cri

teri

a an

d re

cipi

ent r

egis

trat

ion

• N

ICE

(201

3) Q

ualit

y st

anda

rd e

nd o

f lif

e ca

re.

• R

CN (2

012)

Adv

ance

d N

urse

P

ract

itio

ner:

An

RCN

gui

de to

the

adva

nced

nur

se ro

le a

ccre

dita

tion

.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

• N

ICE

(201

4) S

afe

staf

fing

for

nurs

ing

in a

dult

inpa

tien

t war

ds in

ac

ute

hosp

ital

s.

• P

refe

rred

Pri

orit

ies

of C

are

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

(con

tinu

ed)

3

29


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5Se

e ab

ove.

See

abov

e.Se

e ab

ove.

• im

pact

of p

rurit

us o

n w

ell b

eing

and

sle

ep p

atte

rns

• th

e lif

esty

le ri

sk fa

ctor

s th

at m

ay in

fluen

ce d

isea

se

seve

rity

e.g

. sm

okin

g, a

lcoh

ol, o

besi

ty, d

epre

ssio

n

• ty

pes

of in

vest

igat

ion

e.g.

live

r bio

psy,

ult

raso

und

scan

ning

, how

to in

terp

ret r

esul

ts, a

ppro

pria

te

trea

tmen

t opt

ions

and

loca

l gui

delin

es

• w

hen

to re

fer t

o sp

ecia

list l

iver

team

• al

tere

d bo

dy im

age

• en

d of

life

car

e in

rela

tion

to p

atie

nts

wit

h ch

roni

c liv

er d

isea

se.

Kno

ws

how

to:

• un

dert

ake

a co

mpr

ehen

sive

clin

ical

ass

essm

ent o

f pa

tien

ts w

ith

liver

dis

ease

• id

enti

fy s

igns

of l

iver

dis

ease

in s

tool

s an

d ur

ine

• co

mm

unic

ate

the

purp

ose,

resu

lts

and

mea

ning

of

rele

vant

inve

stig

atio

ns

• co

mm

unic

ate

to p

atie

nts,

fam

ily/c

arer

s an

d st

aff

the

need

for i

nfec

tion

pre

vent

ion

and

cont

rol

• re

cogn

ise

sign

s of

live

r dis

ease

and

impl

emen

t ap

prop

riate

act

ions

and

/or r

efer

ral t

o sp

ecia

list

team

s.

See

abov

e.Se

e ab

ove.

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

(con

tinu

ed)

3

30


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

6U

nder

take

s a

com

preh

ensi

ve

phys

ical

as

sess

men

t an

d fo

llow

s up

with

ap

prop

riat

e ac

tion,

in

clud

ing

refe

rral

to

med

ical

sp

ecia

lists

fo

r rel

evan

t ch

roni

c he

alth

car

e co

nditi

ons.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. U

nder

take

s a

com

preh

ensi

ve p

hysi

cal

asse

ssm

ent a

nd p

atie

nt ri

sk p

rofil

ing

incl

udin

g th

e ea

rly

dete

ctio

n of

oth

er d

isea

ses

and

the

iden

tific

atio

n of

co-

mor

bidi

ties

.

b. P

rovi

des

expe

rt c

are

and

inte

r-pr

ofes

sion

al

colla

bora

tive

pra

ctic

e an

d co

nsul

tati

on to

in

divi

dual

pat

ient

s an

d se

rvic

e us

ers

acro

ss

spec

ific

pati

ent p

athw

ays

base

d on

hol

isti

c as

sess

men

t, n

atio

nal g

uide

lines

, spe

cial

ist

com

pete

nces

and

bes

t pra

ctic

e, d

ocum

enti

ng

this

car

e as

an

acco

unta

ble

prac

titi

oner

.

c. D

iscu

sses

wit

h pa

tien

ts a

nd fa

mily

/car

er

the

sign

ifica

nce

of m

edic

al in

vest

igat

ions

, tes

t re

sult

s, p

rogn

osis

and

trea

tmen

t opt

ions

.

d. M

onit

ors

and

advi

ses

on n

utri

tion

al in

take

an

d su

pple

men

ts in

col

labo

rati

on w

ith

diet

icia

n to

pro

vide

opt

imal

nut

riti

on.

e. Im

plem

ents

and

doc

umen

ts a

n ap

prop

riat

e m

anag

emen

t pla

n.

f. Es

tabl

ishe

s pa

tien

t con

cord

ance

wit

h tr

eatm

ent a

nd re

cogn

ises

pat

ient

’s in

divi

dual

tr

eatm

ent c

hoic

es.

g. K

eeps

up

to d

ate

wit

h be

st p

ract

ice

for

spec

ific

pati

ent p

athw

ays

thro

ugh

nati

onal

sp

ecia

list f

orum

s, jo

urna

ls a

nd n

etw

orki

ng.

• re

leva

nt N

ICE

guid

elin

es a

nd s

tand

ards

• e

arly

sig

ns a

nd s

ympt

oms

of o

ther

maj

or

dise

ases

, suc

h as

dia

bete

s, h

eart

dis

ease

and

en

docr

ine

dise

ase

• im

pact

of p

regn

ancy

on

the

liver

• si

gns

of li

ver d

isea

se a

nd th

e im

pact

of

co-m

orbi

diti

es

• in

terp

reti

ng c

hang

es to

blo

od c

hem

istr

y in

live

r di

seas

e, s

uch

as li

ver e

nzym

es, s

ynth

etic

func

tion

s su

ch a

s IN

R/p

roth

rom

bin

tim

es a

nd a

lbum

in

• in

vest

igat

ions

suc

h as

Dop

pler

sca

n, e

ndos

copy

, en

dosc

opic

retr

ogra

de c

hola

ngio

panc

reto

grap

hy

(ER

CP),

mag

neti

c re

sona

nce

imag

ing

(MR

I)

• in

dep

th u

nder

stan

ding

of a

lter

ed

path

ophy

siol

ogy,

suc

h as

am

mon

ia le

vels

in

hepa

tic

ence

phal

opat

hy a

nd e

ffec

ts o

f spl

anch

nic

circ

ulat

ion

on p

orta

l hyp

erte

nsio

n an

d re

leva

nce

to c

urre

nt m

anag

emen

t str

ateg

ies

• kn

owle

dge

of p

reci

pita

ting

fact

ors

of h

epat

ic

ence

phal

opat

hy a

nd p

reve

ntat

ive

mea

sure

s

• p

atie

nt c

ompl

ianc

e, a

dher

ence

and

con

cord

ance

• m

easu

rem

ents

of s

ever

ity

and

surv

ival

bas

ed o

n bl

ood

resu

lts,

suc

h as

UKE

LD, M

ELD

, Chi

lds

Pugh

sc

ore

and

othe

r phy

sica

l fac

tors

suc

h as

asc

ites

an

d he

pati

c en

ceph

alop

athy

• en

d of

life

car

e an

d it

s m

anag

emen

t.

Kno

ws

how

to:

• u

nder

take

a d

etai

led,

com

preh

ensi

ve p

hysi

cal

asse

ssm

ent i

n ac

cord

ance

wit

h lo

cal g

uide

lines

• re

cogn

ise

sign

s an

d sy

mpt

oms

and

im

plem

ent a

ppro

pria

te a

ctio

ns fo

r co

mpl

icat

ions

of l

iver

dis

ease

• in

terp

ret a

rang

e of

blo

od re

sult

s

• co

mm

unic

ate

to p

atie

nts

the

impa

ct o

f co

-mor

bidi

ties

on

thei

r liv

er d

isea

se

• d

iffer

enti

ate

betw

een

hepa

tic

ence

phal

opat

hy

and

alco

hol w

ithd

raw

al

• as

sess

for s

igns

and

sym

ptom

s of

acu

te a

lcoh

ol

wit

hdra

wal

uti

lisin

g a

valid

ated

sev

erit

y sc

ale

• V

alue

s le

arni

ng.

• W

orks

in p

artn

ersh

ip.

• E

mpo

wer

ing.

• E

mbr

aces

diff

eren

t per

spec

tive

s.

• A

naly

tica

l.

• A

tten

tion

to d

etai

l.

• M

odel

s be

st p

ract

ice.

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

(con

tinu

ed)

3

31


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

6•

iden

tify

pre

and

pos

t mor

bid

men

tal h

ealt

h is

sues

• m

onit

or o

ptim

al n

utri

tion

al s

tatu

s

• ac

t as

a m

ento

r to

othe

rs.

7U

nder

take

s a

com

preh

ensi

ve

phys

ical

as

sess

men

t an

d fo

llow

s up

with

ap

prop

riat

e ac

tion,

in

clud

ing

refe

rral

to

med

ical

sp

ecia

lists

fo

r rel

evan

t ch

roni

c an

d ac

ute

heal

th c

are

cond

ition

s.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. A

sses

ses,

dia

gnos

es a

nd tr

eats

peo

ple

wit

h on

-goi

ng li

ving

dis

ease

and

its

com

plic

atio

ns.

b. U

nder

take

s a

med

ical

his

tory

, com

plet

es a

de

taile

d ph

ysic

al a

nd n

ursi

ng e

xam

inat

ion,

fo

rmul

ates

a d

iagn

osis

, ini

tiat

es in

vest

igat

ions

an

d/or

trea

tmen

ts a

nd re

fers

to s

peci

alis

t te

ams

as a

ppro

pria

te.

c. D

iagn

oses

new

or w

orse

ning

com

plic

atio

ns

of a

cute

and

chr

onic

live

r dis

ease

.

d. Id

enti

fies

earl

y si

gns

of o

ther

dis

ease

s.

e. P

rovi

des

the

pati

ent w

ith

info

rmat

ion

on h

ow to

man

age

and

mon

itor

spe

cific

sy

mpt

oms.

f. Im

plem

ents

end

of l

ife c

are

for t

he p

atie

nt

and

thei

r fam

ily, p

rovi

des

supp

ort a

nd re

fers

to

the

appr

opri

ate

heal

th p

rofe

ssio

nals

.

• a

ll ca

uses

of l

iver

dis

ease

incl

udin

g th

ose

rela

ted

to o

ccup

atio

n an

d tr

avel

• c

ompl

icat

ions

of a

cute

and

chr

onic

live

r dis

ease

• d

esig

n, im

plem

ent a

nd e

valu

ate

a m

anag

emen

t pl

an th

at in

clud

ed th

e sp

ecifi

c si

gns

and

sym

ptom

s or

sid

e ef

fect

s: s

uch

as:

– pr

urit

us

– sk

in ra

shes

as

side

eff

ects

of d

rug

trea

tmen

ts

espe

cial

ly in

rela

tion

to v

iral

hep

atit

is

– hy

pote

nsio

n du

e to

dru

g re

late

d, s

uch

as

prop

rano

lol,

and

non-

drug

rela

ted

reas

ons

such

as

dec

ompe

nsat

ed li

ver d

isea

se

– ja

undi

ce

– bi

liary

com

plic

atio

ns s

uch

as c

hole

cyst

itis

and

/or

cho

lang

itis

– po

rtal

hyp

erte

nsio

n an

d oe

soph

agea

l var

ices

– as

cite

s/sp

onta

neou

s ba

cter

ial p

erit

onit

is

– he

pato

rena

l fai

lure

– he

pati

c en

ceph

alop

athy

– ri

sk o

f cer

ebra

l oed

ema

in a

cute

live

r fai

lure

– se

psis

whi

ch o

ften

pre

cipi

tate

s va

rice

al b

leed

ing

or h

epat

ic e

ncep

halo

path

y

– ca

rdio

vasc

ular

and

resp

irat

ory

com

plic

atio

ns

– co

agul

opat

hy

– re

cogn

ise

the

sign

s an

d sy

mpt

oms

of a

lcoh

ol

and

/or d

rug

wit

hdra

wal

• tr

eatm

ent r

egim

es, i

nclu

ding

elig

ibili

ty a

nd

suit

abili

ty c

rite

ria

for d

iffer

ent l

iver

dis

ease

s

• o

ptio

ns fo

llow

ing

failu

re o

f tre

atm

ent,

suc

h as

ea

rly

refe

rral

for l

iver

tran

spla

ntat

ion

asse

ssm

ent

in c

hron

ic li

ver d

isea

se

• p

allia

tion

of s

ympt

oms

such

as

chem

o-em

bolis

atio

n or

par

acen

tesi

s an

d pl

anni

ng fo

r en

d of

life

car

e.

(con

tinu

ed)

• R

ole

mod

el.

• In

terp

rofe

ssio

nal w

orki

ng.

• C

olla

bora

tive

.

• In

clus

ive.

• S

tron

g cl

inic

al le

ader

ship

.

• C

halle

nges

ass

umpt

ions

.

• C

ham

pion

s pe

rson

-cen

tred

ap

proa

ches

.

• C

halle

nges

ass

umpt

ion

and

take

n fo

r gra

nted

way

s of

wor

king

.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pat

ient

s.

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

(con

tinu

ed)

3

32


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7Se

e ab

ove.

See

abov

e.Se

e ab

ove.

Kno

ws

how

to:

• u

nder

take

a d

etai

led

clin

ical

and

nu

rsin

g as

sess

men

t

• u

nder

take

an

abdo

min

al a

sses

smen

t and

oth

er

syst

ems

as a

ppro

pria

te.

• e

xpla

in s

igni

fican

ce o

f any

inve

stig

atio

ns

to p

atie

nts

• in

itia

te in

vest

igat

ions

app

ropr

iate

ly

• a

ct o

n in

vest

igat

ions

and

inte

rpre

t res

ults

in

clud

ing

liver

scr

een

• fo

rmul

ate

an a

ppro

pria

te m

anag

emen

t pla

n in

clud

ing,

whe

re a

ppro

pria

te, e

nd o

f life

car

e

• id

enti

fy a

cute

alc

ohol

wit

hdra

wal

and

saf

ely

prov

ide

phar

mac

olog

ical

man

agem

ent o

f sy

mpt

oms

duri

ng a

n ep

isod

e of

acu

te

alco

hol w

ithd

raw

al

• a

dmin

iste

r tre

atm

ent w

ithi

n th

eir s

peci

alis

t rol

e as

a n

on-m

edic

al p

resc

ribe

r

• re

cogn

ise,

man

age

and

refe

r pat

ient

s in

rela

tion

to

thei

r co-

mor

bidi

ties

• a

sses

s co

mpe

tenc

e of

nur

ses

unde

rtak

ing

cl

inic

al a

sses

smen

ts

• a

ct a

s a

role

mod

el.

See

abov

e.Se

e ab

ove.

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

(con

tinu

ed)

3

33


Ass

esse

s, in

col

labo

rati

on w

ith

the

pati

ent (

youn

g pe

ople

, adu

lts,

fam

ily/

care

rs),

thei

r he

alth

car

e ne

eds,

taki

ng in

to a

ccou

nt th

e im

pact

of

thei

r ag

e, v

ulne

rabi

lity

, the

ir li

fest

yle,

cul

tura

l and

eth

nic

back

grou

nd4 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

5As

sess

es, i

n co

llabo

ratio

n w

ith th

e pa

tient

thei

r he

alth

car

e ne

eds,

taki

ng

into

acc

ount

th

eir a

ge,

vuln

erab

ility

, th

eir l

ifest

yle,

cu

ltura

l an

d et

hnic

ba

ckgr

ound

.

Core

1

HW

B2

HW

B5

HW

B6

HW

B7

Core

6

a. U

nder

take

s a

holis

tic

heal

th c

are

ne

eds

asse

ssm

ent.

b. Id

enti

fies

pati

ents

at r

isk

from

live

r dis

ease

.

c. E

xplo

res

the

pati

ent’

s cu

rren

t life

styl

e, h

opes

an

d ex

pect

atio

ns.

d. D

iscu

sses

the

pati

ent’

s cu

ltur

al/f

amily

/et

hnic

bac

kgro

und

and

iden

tifie

s pe

rson

al

pref

eren

ces.

e. Id

enti

fies

vuln

erab

le in

divi

dual

s.

f. M

aint

ains

con

fiden

tial

ity

in re

lati

on to

pa

tien

t inf

orm

atio

n an

d da

ta.

g. D

ocum

ents

com

preh

ensi

ve a

sses

smen

t.

h. U

ses

all a

vaila

ble

reso

urce

s to

pro

vide

in

form

atio

n an

d to

asc

erta

in th

e pa

tien

t un

ders

tand

s th

eir i

llnes

s/tr

eatm

ent o

ptio

ns in

th

eir p

refe

rred

lang

uage

.

i. Es

tabl

ishe

s pa

tien

t con

cord

ance

wit

h tr

eatm

ent a

nd re

cogn

ises

pat

ient

’s in

divi

dual

tr

eatm

ent c

hoic

es.

• th

e im

plic

atio

ns o

f diff

eren

t life

st

ages

, life

styl

es a

nd ri

sk fa

ctor

s on

th

e de

velo

pmen

t and

pro

gres

sion

of

acut

e an

d ch

roni

c liv

er c

ondi

tion

s an

d at

end

of l

ife

• d

iffer

ent c

ultu

res

and

fait

hs a

nd

the

pote

ntia

l im

pact

of t

hese

upo

n th

e pa

tien

t’s

pers

onal

bel

iefs

and

vi

ewpo

ints

• th

e ra

nge

of re

sour

ces

for i

nfor

mat

ion

and

supp

ort w

here

the

pati

ent c

ould

be

refe

rred

• o

btai

ning

con

sent

from

the

pati

ent

• le

gal a

nd e

thic

al a

spec

ts o

f con

sent

.

Kno

ws

how

to:

• u

nder

take

hol

isti

c as

sess

men

t in

clud

ing

lifes

tyle

, sex

ual h

ealt

h,

soci

al a

nd m

enta

l hea

lth

need

s

• u

se a

lcoh

ol s

cree

ning

tool

• c

onsu

lts,

com

mun

icat

es a

nd re

fers

to

appr

opri

ate

supp

ort

• re

cogn

ise

vuln

erab

ility

acr

oss

the

ag

e sp

ectr

um

• a

cces

s ex

pert

ise

in re

lati

on to

car

ing

for v

ulne

rabl

e in

divi

dual

s

• a

cces

s an

inte

rpre

ter/

cultu

ral m

edia

tor.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• S

uppo

rtiv

e.

• E

ncou

ragi

ng.

• P

rovi

des

choi

ces.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gui

danc

e.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f life

car

e.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2)

Dea

ths

from

Liv

er D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le

peop

le in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as, C

QU

INS

, PR

OM

S e

tc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a re

view

of

pati

ents

who

die

d w

ith

alco

hol-r

elat

ed li

ver d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fi

rst 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

34


Ass

esse

s, in

col

labo

rati

on w

ith

the

pati

ent (

youn

g pe

ople

, adu

lts,

fam

ily/

care

rs),

thei

r he

alth

car

e ne

eds,

taki

ng in

to a

ccou

nt th

e im

pact

of

thei

r ag

e, v

ulne

rabi

lity

, the

ir li

fest

yle,

cul

tura

l and

eth

nic

back

grou

nd (c

onti

nued

)4 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

6As

sess

es, i

n co

llabo

ratio

n w

ith th

e pa

tient

thei

r he

alth

car

e ne

eds,

taki

ng

into

acc

ount

th

eir a

ge,

vuln

erab

ility

, th

eir l

ifest

yle,

cu

ltura

l an

d et

hnic

ba

ckgr

ound

.

Core

1

HW

B2

HW

B5

HW

B6

HW

B7

Core

6

a. E

xplo

res

the

impa

ct o

f the

pat

ient

’s

agre

emen

t or r

esis

tanc

e to

trea

tmen

t opt

ions

on

thei

r liv

er c

ondi

tion

with

rega

rd to

thei

r cu

ltura

l and

eth

nic

back

grou

nd a

nd li

fe c

hoic

es.

• c

ultu

re, r

elig

ion

and

ethn

icit

y on

hea

lth

belie

fs

• li

fest

yle

impa

ct o

n liv

er h

ealt

h in

clud

ing

chao

tic

lifes

tyle

, dru

gs, a

lcoh

ol a

nd o

besi

ty

• im

pact

of l

iver

dis

ease

on

life

styl

e an

d se

xual

hea

lth

• c

linic

al g

over

nanc

e

Kno

ws

how

to:

• a

sses

s lif

esty

le fa

ctor

s in

col

labo

rati

on w

ith

th

e pa

tien

t

• h

ow to

ass

ess

drin

king

his

tory

and

use

tool

s to

as

sess

risk

s to

pat

ient

com

plia

nce

and

safe

ty

• m

anag

e re

fusa

l of c

are/

trea

tmen

t by

pati

ent,

fa

mily

or c

arer

s, a

nd re

fer t

o a

heal

th c

are

prof

essi

onal

whe

re a

ppro

pria

te.

• M

odel

s be

st p

ract

ice.

• B

uild

s re

lati

onsh

ip w

ith

peer

s.

• S

hare

s id

eas.

• F

acili

tate

s in

volv

emen

t of

stak

ehol

ders

.

• M

edic

o-le

gal i

mpl

icat

ion.

• W

orks

in p

artn

ersh

ip.

• E

mpo

wer

ing.

• E

mbr

aces

diff

eren

t per

spec

tive

s.

Gen

eric

(con

tinu

ed)

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Spec

ific

• E

qual

ity

impa

ct a

sses

smen

ts.

• M

IND

.

• N

HS

Publ

ic H

ealt

h En

glan

d - s

exua

l he

alth

.

• N

ICE

CG 1

00 A

lcoh

ol-u

se d

isor

ders

: ph

ysic

al c

ompl

icat

ions

ww

w.

guid

ance

.nic

e.or

g.uk

/CG

100.

(con

tinu

ed)

7As

sess

es, i

n co

llabo

ratio

n w

ith th

e pa

tient

thei

r he

alth

car

e ne

eds,

taki

ng

into

acc

ount

th

eir a

ge,

vuln

erab

ility

, th

eir l

ifest

yle,

cu

ltura

l an

d et

hnic

ba

ckgr

ound

.

Core

1

HW

B2

HW

B5

HW

B6

HW

B7

Core

6

a. A

sses

s, d

iagn

ose

and

trea

t pat

ient

s w

ith

on-g

oing

live

r dis

ease

.

b. M

anag

e an

d m

onit

or c

ompl

icat

ions

.

c. A

sses

ses

pati

ents

retu

rnin

g fo

r on-

goin

g fo

llow

-up.

d. R

efer

s pa

tien

ts to

oth

er m

embe

rs o

f the

m

ulti

-dis

cipl

inar

y te

am w

hen

appr

opri

ate.

e. A

udit

s as

sess

men

t doc

umen

tati

on in

co

llabo

rati

on w

ith

the

mul

ti-d

isci

plin

ary

team

.

f. Pa

rtic

ipat

es in

mul

ti-d

isci

plin

ary

pa

tien

t con

fere

nces

.

g. K

eeps

pat

ient

s’ g

ener

al p

ract

itio

ners

, an

d co

mm

unit

y te

ams/

serv

ices

info

rmed

of

on-g

oing

con

sult

atio

n, h

ealt

h ca

re n

eeds

and

as

sess

men

t pro

gres

s.

• re

ferr

al s

yste

ms

and

com

mun

icat

ion

syst

ems

wit

h ge

nera

l pra

ctit

ione

rs, c

omm

unit

y te

ams

and

scho

ol n

urse

s.

Kno

ws

how

to:

• se

t-up

, org

anis

e an

d ru

n nu

rse-

led

clin

ics

• es

tabl

ish

tele

phon

e su

ppor

t and

cou

nsel

ling

syst

ems.

• R

ole

mod

el.

• Co

llabo

rati

ve.

• In

clus

ive.

• Pa

rtic

ipat

ive.

• Ch

alle

nges

ass

umpt

ions

.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

es.

• Ch

alle

nges

ass

umpt

ion

and

take

n fo

r gra

nted

way

s of

wor

king

.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h

for p

atie

nts.

35


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7Se

e ab

ove.

See

abov

e.Se

e ab

ove.

See

abov

e.Se

e ab

ove.

• N

ICE

CG 1

15 A

lcoh

ol u

se d

isor

ders

: di

agno

sis,

ass

essm

ent a

nd

man

agem

ent o

f har

mfu

l dri

nkin

g an

d al

coho

l dep

ende

nce

ww

w.g

uida

nce.

nice

.org

.uk/

CG11

5.

• N

ICE

PH 2

4 A

lcoh

ol-u

se d

isor

ders

–

prev

enti

ng th

e de

velo

pmen

t of

haza

rdou

s an

d ha

rmfu

l dri

nkin

g.

ww

w.g

uida

nce.

nice

.org

.uk/

PH24

.

Ass

esse

s, in

col

labo

rati

on w

ith

the

pati

ent (

youn

g pe

ople

, adu

lts,

fam

ily/

care

rs),

thei

r he

alth

car

e ne

eds,

taki

ng in

to a

ccou

nt th

e im

pact

of

thei

r ag

e, v

ulne

rabi

lity

, the

ir li

fest

yle,

cul

tura

l and

eth

nic

back

grou

nd (c

onti

nued

)4

36


Dev

elop

s an

d ev

alua

tes

a se

lf-m

anag

emen

t pla

n w

ith

the

pati

ent w

ho h

as p

redi

spos

ing

fact

ors

to li

ver

dise

ase

5 Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5D

evel

ops

and

eval

uate

s a

self-

man

agem

ent

plan

with

th

e pa

tient

w

ho h

as

pred

ispo

sing

fa

ctor

s to

live

r di

seas

e.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. A

sses

smen

t of p

atie

nt ri

sk

fact

ors

for l

iver

dis

ease

.

b. D

iscu

sses

wit

h th

e pa

tien

t th

eir r

isk

fact

ors.

c. D

evel

ops

and

reco

rds

a se

lf-m

anag

emen

t pla

n w

ith

the

pati

ent/

fam

ily/c

arer

s.

d. U

ses

pati

ent-

held

reco

rd/

diar

ies.

e. Im

plem

ents

app

ropr

iate

br

ief a

dvic

e an

d in

terv

enti

ons.

f. D

ocum

ents

inte

rven

tion

s an

d sh

ares

info

rmat

ion

wit

h th

e m

ulti

-dis

cipl

inar

y te

am,

as a

ppro

pria

te.

g. E

valu

ates

sel

f m

anag

emen

t pla

n an

d go

als

set.

h. D

emon

stra

tes

skill

s in

med

iati

on, c

onfli

ct

reso

luti

on a

nd a

dvoc

acy.

• th

e ne

eds

of p

atie

nts

who

hav

e pr

edis

posi

ng

fact

ors

to li

ver d

isea

se s

uch

as a

lcoh

ol, v

iral

, ob

esit

y, g

enet

ic p

redi

spos

itio

n, d

iabe

tes,

se

xual

hea

lth

• av

aila

ble

reso

urce

s an

d w

here

and

how

to

acce

ss th

em

• ho

w c

ultu

ral,

ethn

ic a

nd re

ligio

us b

ackg

roun

ds

influ

ence

life

styl

e ch

oice

s

• th

e im

pact

of l

ivin

g w

ith

a ch

roni

c co

ndit

ion

in

rela

tion

to s

elf-

man

agem

ent a

nd a

dher

ence

• ti

mel

y di

scus

sion

of e

nd o

f life

car

e.

Kno

ws

how

to:

• w

ork

colla

bora

tive

ly w

ith

the

pati

ent

• de

velo

p an

d m

aint

ain

a se

lf-m

anag

emen

t pla

n th

at a

chie

ves

the

pote

ntia

l of t

he in

divi

dual

and

m

aint

ains

thei

r mot

ivat

ion

and

confi

denc

e

• de

velo

p go

als

colla

bora

tive

ly th

at a

re S

MA

RT

(spe

cific

, mea

sura

ble,

ach

ieva

ble,

real

isti

c an

d ti

me-

spec

ific)

• be

nchm

ark

arou

nd th

e ac

tivi

ties

of d

aily

livi

ng

and

impr

ovem

ent s

trat

egie

s

• ho

w a

nd w

here

to c

onfid

enti

ally

reco

rd a

nd

repo

rt in

form

atio

n, th

e el

ectr

onic

reco

rd a

nd

data

base

s, a

nd d

ata

that

can

sup

port

qua

lity

impr

ovem

ent t

hrou

gh s

hari

ng a

nd p

eer-

revi

ew

• re

fer t

o pa

lliat

ive

care

ser

vice

s an

d ke

ep G

P pr

acti

ce a

nd re

late

d co

mm

unit

y te

ams

info

rmed

.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• Su

ppor

tive

.

• En

cour

agin

g.

• Pr

ovid

es c

hoic

es.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• N

on-ju

dgm

enta

l.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

Gen

eric

•

NM

C do

cum

ents

and

gui

danc

e.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gui

danc

e.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f life

car

e.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2)

Dea

ths

from

Liv

er D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le

peop

le in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as, C

QU

INS,

PR

OM

S et

c.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

).

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a re

view

of

pati

ents

who

die

d w

ith

alco

hol-r

elat

ed li

ver d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (

Impr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fi

rst 2

4 ho

urs.

• N

HS

Engl

and

(201

3) T

he 6

Cs.

(con

tinu

ed)

37


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

6D

evel

ops

and

eval

uate

s a

self-

man

agem

ent

plan

with

th

e pa

tient

w

ho h

as

pred

ispo

sing

fa

ctor

s to

live

r di

seas

e.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. W

orks

col

labo

rati

vely

wit

h th

e pa

tien

t and

/or

car

ers

to a

sses

s th

eir l

evel

of u

nder

stan

ding

of

thei

r con

diti

on.

b. Id

enti

fies

in c

olla

bora

tion

wit

h th

e pa

tien

t an

d/or

fam

ily/c

arer

s, w

ho h

ave

pred

ispo

sing

fa

ctor

s fo

r liv

er d

isea

se, t

heir

nee

ds a

nd g

ives

ap

prop

riat

e ad

vice

.

c. D

iscu

sses

var

ious

life

styl

e ch

oice

s w

ith

the

pati

ent a

nd p

ossi

ble

impl

icat

ions

for t

heir

im

med

iate

and

long

-ter

m h

ealt

h.

d. Id

enti

fies

agre

ed p

atie

nt g

oals

that

can

be

eval

uate

d an

d re

view

ed p

erio

dica

lly.

e. A

gree

s ap

prop

riat

e ri

sk p

rofil

ing

and

inve

stig

atio

ns a

s pa

rt o

f the

pat

ient

’s s

elf-

man

agem

ent p

lan.

f. In

tegr

ates

sup

port

str

ateg

ies

for p

atie

nts

wit

h de

teri

orat

ing

heal

th.

g. H

elps

pat

ient

to n

avig

ate

thei

r way

thro

ugh

the

heal

th c

are

syst

em to

ach

ieve

the

mos

t ap

prop

riat

e ca

re.

• th

e ba

rrie

rs to

con

tinu

ity

of c

are

and

how

they

ca

n be

ove

rcom

e

• lo

cal n

etw

orks

in th

e ho

spit

al a

nd th

e co

mm

unit

y, a

nd k

now

ledg

e of

how

to b

uild

go

od re

lati

onsh

ips

• lo

ng-t

erm

com

plic

atio

ns a

nd ri

sk p

rofil

ing

appr

oach

es

• de

teri

orat

ion

and

reco

gnit

ion

of c

hron

ic

live

r dis

ease

and

its

impa

ct o

n th

e pa

tien

t a

nd fa

mily

/car

ers

• ke

y ou

tcom

es th

at c

an b

e m

easu

red

and

mon

itore

d

• su

ppor

t str

ateg

ies

for t

hose

wit

h de

teri

orat

ing

heal

th.

Kno

ws

how

to:

• ev

alua

te th

e ou

tcom

es o

f car

e fo

r ind

ivid

uals

and

cl

ient

gro

ups

in re

lati

on to

bot

h cl

inic

al o

utco

mes

an

d th

e pa

tien

t’s

expe

rien

ce

• in

itia

tes

end

of li

fe d

iscu

ssio

ns w

ith

pati

ent i

n co

llabo

rati

on w

ith

mul

ti-d

isci

plin

ary

team

.

• M

odel

s be

st p

ract

ice.

• Em

pow

erin

g.

• Co

llabo

rati

ve.

• In

clus

ive.

• H

ones

t and

ope

n.

• W

orks

in p

artn

ersh

ip.

• Em

brac

es d

iffer

ent p

ersp

ecti

ves.

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

Gro

up

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

).

• N

HS

Engl

and

The

Info

rmat

ion

Stan

dard

.

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

.

• Sk

ills

for H

ealt

h.

Spec

ific

• N

atio

nal S

ervi

ce F

ram

ewor

ks –

Obe

sity

.

• D

H (2

006)

Our

Hea

lth, O

ur C

are,

Our

Say

.

• N

ICE

(201

4-5)

Gui

danc

e on

obe

sity

.

• D

H (2

001)

Exp

ert P

atie

nt.

• R

CN (2

010)

Pri

ncip

les

of

Nur

sing

Pra

ctic

e.

Dev

elop

s an

d ev

alua

tes

a se

lf-m

anag

emen

t pla

n w

ith

the

pati

ent w

ho h

as p

redi

spos

ing

fact

ors

to li

ver

dise

ase

(con

tinu

ed)

5

38


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7D

evel

ops

and

eval

uate

s a

self-

man

agem

ent

plan

with

th

e pa

tient

w

ho h

as

pred

ispo

sing

fa

ctor

s to

live

r di

seas

e.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. E

nabl

es c

ontin

uity

of c

are

for t

hose

pa

tient

s w

ith c

ompl

ex h

ealth

nee

ds to

im

plem

ent t

heir

self-

man

agem

ent p

lan,

su

ch a

s in

the

com

mun

ity.

b. W

orks

col

labo

rati

vely

to m

anag

e th

e pa

tien

t’s

sym

ptom

s su

ch a

s as

cite

s, h

epat

ic

ence

phal

opat

hy b

etw

een

prim

ary

and

seco

ndar

y ca

re.

c. R

ecog

nise

s ea

rly

need

for d

iscu

ssio

n ab

out

pati

ents

pre

fere

nces

in e

nd o

f life

pla

nnin

g an

d ca

re.

d. D

evel

ops

a co

llabo

rati

ve p

lan

of c

are

wit

h pa

tien

t and

fam

ily fo

r man

agin

g en

d-st

age

liver

dis

ease

, pal

liati

on a

nd s

ympt

om c

ontr

ol

for e

nd o

f life

car

e.

• th

e pr

inci

ples

of c

are

in re

spec

t to

com

plex

he

alth

nee

ds

• lo

ng-t

erm

and

chr

onic

dis

ease

del

iver

y ca

re

path

way

s in

clud

ing

end

of li

fe c

are

• ch

oice

s av

aila

ble

to th

e pa

tien

t for

end

of l

ife c

are

arou

nd h

ome,

hos

pice

and

hos

pita

l.

Kno

ws

how

to:

• pl

an, d

eliv

er a

nd e

valu

ate

care

for p

eopl

e w

ith

pred

ispo

sing

fact

ors

of li

ver d

isea

se

• bu

ild a

nd s

tren

gthe

n co

mm

unit

y an

d ho

spit

al

rela

tion

ship

s to

cre

ate

seam

less

ser

vice

s

• in

nova

te a

nd im

prov

e se

rvic

es to

enh

ance

he

alth

-rel

ated

qua

lity

of li

fe

• re

cogn

ises

whe

n en

d of

life

car

e ne

eds

to b

e di

scus

sed

and

plan

ned

for

• le

ad p

atie

nt c

onfe

renc

es a

nd p

eer r

evie

w

• en

gage

wit

h pa

tien

t to

expl

ore

end

of li

fe c

hoic

es

• w

ork

wit

h th

e m

ulti

-dis

cipl

inar

y te

am a

nd

prim

ary

care

to p

lan

end

of li

fe c

are.

• R

ole

mod

el.

• In

terp

rofe

ssio

nal w

orki

ng.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

es.

• Ch

alle

nges

ass

umpt

ions

and

ta

ken

for g

rant

ed w

ays

of w

orki

ng.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pat

ient

s.

• St

rong

clin

ical

lead

ersh

ip.

• V

isib

le in

pra

ctic

e se

ttin

gs.

See

abov

e.

Dev

elop

s an

d ev

alua

tes

a se

lf-m

anag

emen

t pla

n w

ith

the

pati

ent w

ho h

as p

redi

spos

ing

fact

ors

to li

ver

dise

ase

(con

tinu

ed)

5

39


Wor

ks a

long

side

and

wit

h th

e pa

tien

t (an

d fa

mil

ies/

care

rs) t

o ad

dres

s th

e ps

ycho

logi

cal a

nd s

ocia

l im

pact

of t

heir

con

diti

on6 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

1-4

Prov

ides

si

mpl

e ps

ycho

logi

cal

and

soci

al

inte

rven

tions

an

d se

eks

supp

ort

appr

opri

atel

y.

KSF

Core

1

HW

B2

HW

B4

HW

B5

HW

B6

a. P

rovi

des

supp

ort a

nd e

ncou

rage

men

t by

fam

iliar

isin

g th

e pa

tien

t wit

h th

e w

ard

or c

linic

env

iron

men

t (su

ch a

s to

ilet

loca

tion

, mea

l tim

es, v

isit

ing

tim

es).

b. C

omm

unic

ates

trea

tmen

t pla

ns c

lear

ly

and

reco

gnis

es th

at h

ospi

talis

atio

n is

a

maj

or s

tres

s fa

ctor

for p

atie

nts.

c. L

iste

ns a

nd e

mpa

this

es w

ith

the

pati

ent,

doc

umen

ts in

form

atio

n an

d di

scus

ses

wit

h al

l inv

olve

d in

the

care

, an

d ta

kes

appr

opri

ate

acti

on.

d. S

eeks

sup

port

from

col

leag

ues

in

resp

onse

to d

istr

essi

ng c

onve

rsat

ions

.

• v

erba

l and

non

-ver

bal c

omm

unic

atio

n in

clud

ing

para

lingu

isti

cs s

uch

as s

ilenc

e, s

ighs

, clic

king

of t

he

tong

ue a

nd o

ther

non

-ver

bal u

tter

ance

s.

• A

war

e of

role

lim

itat

ions

and

w

hen

to o

btai

n he

lp.

• P

erso

n ce

ntre

d an

d co

mpa

ssio

nate

.

• L

iste

ns.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• C

onfid

enti

al.

• P

ride

in w

ork.

• R

espe

ctfu

l.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

an

d gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f lif

e ca

re.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om L

iver

Dis

ease

. Im

plic

atio

ns fo

r end

of l

ife c

are.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(W

illia

ms

et a

l, 20

14)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a

revi

ew o

f pat

ient

s w

ho d

ied

wit

h al

coho

l-re

late

d liv

er d

isea

se,

Lond

on, N

CEPO

D.

5W

orks

al

ongs

ide

the

patie

nt a

nd

fam

ilies

/car

ers

to a

ddre

ss

psyc

holo

gica

l an

d so

cial

im

pact

of t

heir

co

nditi

on.

KSF

Core

1

HW

B2

HW

B4

HW

B5

HW

B6

a. Id

enti

fies

verb

al a

nd n

on-v

erba

l si

gns

of d

istr

ess,

sup

port

s th

e pa

tien

t,

disc

usse

s w

ith

the

med

ical

team

s an

d re

fers

to th

e ps

ycho

logy

team

or l

ocal

ps

ycho

logy

ser

vice

.

b. A

sses

ses

pati

ent a

nd id

enti

fies

soci

al

prob

lem

s th

at re

quir

e su

ppor

t.

c. Id

enti

fies

soci

al is

sues

, inc

ludi

ng

educ

atio

n, e

mpl

oym

ent,

hou

sing

and

w

elfa

re, a

nd m

akes

app

ropr

iate

refe

rral

to

soci

al w

orke

rs o

r non

-hea

lth

agen

cies

.

d. P

rovi

des

supp

ort a

nd id

enti

fies

psyc

holo

gica

l and

soc

ial n

eeds

in

rela

tion

to th

e im

pact

of t

he c

ondi

tion

in

gen

eral

e.g

. sti

gma

rela

ted

to c

hron

ic

liver

dis

ease

.

e. In

itia

tes

com

mun

icat

ion

duri

ng

asse

ssm

ent a

nd d

urin

g th

e pa

tien

t’s

jour

ney

usin

g op

en/c

lose

d qu

esti

ons

and

prov

ides

an

envi

ronm

ent f

or e

ffec

tive

co

mm

unic

atio

n.

f. Id

enti

fies

com

mun

icat

ion

prob

lem

s w

ithi

n fa

mily

rela

tion

ship

s an

d/or

par

tner

re

lati

onsh

ips.

g. R

aise

s co

ncer

ns to

app

ropr

iate

m

embe

rs o

f the

MD

T in

pri

mar

y or

se

cond

ary

care

.

• s

igns

and

sym

ptom

s of

alt

ered

men

tal s

tate

, mem

ory

loss

• c

ultu

ral e

xpre

ssio

ns/w

ays

of e

xpre

ssin

g di

stre

ss a

nd

pain

• c

ultu

ral v

aria

tion

s in

way

s of

com

mun

icat

ion

• d

iffer

ent c

omm

unic

atio

n st

rate

gies

• p

sych

olog

ical

sup

port

ser

vice

s or

oth

er re

sour

ces

avai

labl

e su

ch a

s bi

lingu

al h

ealt

h ad

voca

tes

• h

ow to

sup

port

pat

ient

s to

con

cord

wit

h tr

eatm

ent

• h

ow to

ena

ble

pati

ents

to m

anag

e ex

pect

atio

ns

• m

anag

e yo

ung

peop

le’s

and

adu

lts

need

for l

ong

term

car

e

• th

e im

pact

of s

afe

sexu

al h

ealt

h on

rela

tion

ship

s

• th

e ne

eds

of h

omel

ess

peop

le a

nd a

war

enes

s of

loca

l ho

mel

ess

care

pat

hway

s

• m

anag

ing

the

stig

ma

and

publ

ic a

ssum

ptio

ns a

roun

d ch

roni

c liv

er d

isea

se e

.g. j

aund

ice

and

asci

tes

• th

e so

cial

impa

ct o

f alt

ered

men

tal s

tate

in re

lati

on to

re

lati

onsh

ips,

em

ploy

men

t, s

elf c

are

• th

e ro

les

of p

sych

olog

ists

and

soc

ial w

orke

rs w

ithi

n th

e m

ulti

disc

iplin

ary

team

.

• th

e ps

ycho

logi

cal i

mpa

ct o

f alc

ohol

and

/ o

r dru

g m

isus

e

Kno

ws

how

to:

• a

sses

s so

cial

sup

port

and

men

tal h

ealt

h.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• S

uppo

rtiv

e.

• E

ncou

ragi

ng.

• E

mpo

wer

ing.

• P

rovi

des

choi

ces.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

40


Wor

ks a

long

side

and

wit

h th

e pa

tien

t (an

d fa

mil

ies/

care

rs) t

o ad

dres

s th

e ps

ycho

logi

cal a

nd s

ocia

l im

pact

of t

heir

con

diti

on (c

onti

nued

)6 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

6W

orks

al

ongs

ide

the

patie

nt a

nd

fam

ilies

/car

ers

to a

ddre

ss

psyc

holo

gica

l an

d so

cial

im

pact

of t

heir

co

nditi

on.

KSF

Core

1

HW

B2

HW

B4

HW

B5

HW

B6

a. A

sses

ses

pati

ent a

nd id

enti

fies

pote

ntia

l or

actu

al p

sych

olog

ical

pro

blem

s.

b. Id

enti

fies

stre

ngth

s an

d w

eakn

ess,

and

an

indi

vidu

al’s

cop

ing

stra

tegi

es w

hen

this

ha

s be

en c

alle

d in

to q

uest

ion;

reas

sure

s th

e in

divi

dual

and

mak

es a

n ap

prop

riat

e re

ferr

al

to th

e ps

ycho

logy

team

or l

ocal

psy

chol

ogy/

psyc

hiat

ry s

ervi

ce.

c. C

reat

es a

nd e

valu

ates

a c

are

plan

bas

ed o

n ac

hiev

able

goa

ls, s

tren

gths

and

wea

knes

ses,

co

ping

str

ateg

ies,

fam

ily a

nd s

ocia

l sup

port

.

d. Id

enti

fies

indi

vidu

als

wit

h lo

ng-t

erm

co

mpl

icat

ions

aff

ecti

ng m

enta

l cap

acit

y su

ch a

s ce

rebr

al a

trop

hy, c

hron

ic h

epat

ic

ence

phal

opat

hy, W

erni

cke’

s en

ceph

alop

athy

or

Kor

sako

ff’s

psy

chos

is.

e. D

emon

stra

tes

the

abili

ty to

inve

stig

ate

pers

onal

bac

kgro

und

and

iden

tify

fam

ily

dyna

mic

s th

at m

ight

hav

e an

impa

ct o

n he

alth

.

f. Id

enti

fies

com

mun

icat

ion

prob

lem

s w

ithi

n fa

mily

rela

tion

ship

s an

d/or

par

tner

re

lati

onsh

ips

and

take

s ap

prop

riat

e ac

tion

.

g. A

dvis

es, s

uppo

rts

and

sign

post

s pa

tien

t and

fa

mily

/car

ers

to c

omm

unit

y se

rvic

es a

vaila

ble

h. M

akes

refe

rral

s w

here

app

ropr

iate

.

Kno

wle

dge

and

unde

rsta

ndin

g of

:

• s

igns

and

sym

ptom

s of

alt

ered

men

tal s

tate

, m

emor

y lo

ss a

nd th

resh

olds

for r

efer

ral t

o ps

ycho

logy

team

or l

ocal

men

tal h

ealt

h se

rvic

e

• th

e cr

iter

ia a

nd th

resh

olds

for r

efer

ral t

o ps

ychi

atry

ser

vice

s

• c

ompl

exit

y of

psy

chol

ogic

al n

eeds

of y

oung

pe

ople

and

adu

lts

in re

lati

on to

long

term

car

e

• s

trat

egie

s us

ed to

sup

port

and

mee

t the

nee

ds

and/

or e

xpec

tati

ons

of h

omel

ess

peop

le.

Kno

ws

how

to:

• m

anag

e ex

tern

al fa

ctor

s e.

g. fa

mily

dyn

amic

s.

• M

odel

s be

st p

ract

ice.

• P

artn

ersh

ip.

• In

clus

ive.

• E

mbr

aces

diff

eren

t per

spec

tive

s.

• V

alue

s ot

hers

.

• D

evel

ops

trus

t.

• W

illin

g to

lear

n fr

om o

wn

prac

tice

.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er

Dis

ease

: Ris

k fa

ctor

s an

d tr

eatm

ent

(fre

e ac

cess

)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is

care

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

41


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7W

orks

al

ongs

ide

the

patie

nt a

nd

fam

ilies

/car

ers

to a

ddre

ss

psyc

holo

gica

l an

d so

cial

im

pact

of t

heir

co

nditi

on.

KSF

Core

1

Core

3

HW

B2

HW

B4

HW

B5

HW

B6

a. A

sses

ses

anxi

ety

and

depr

essi

on u

sing

risk

pr

ofilin

g to

ols

copi

ng s

trat

egie

s; im

plem

ents

ca

re a

nd c

arri

es o

ut a

n ev

alua

tion

bas

ed o

n th

e pr

oble

ms

iden

tifie

d.

b. U

nder

take

s as

sess

men

t th

at in

clud

es

men

tal h

ealt

h; id

enti

fies

men

tal h

ealt

h is

sues

and

psy

cho-

soci

al is

sues

and

mak

es

appr

opri

ate

refe

rral

(s).

c. R

efer

s to

and

wor

ks c

lose

ly w

ith

so

cial

ser

vice

s.

d. R

ecog

nise

s th

e ne

eds

of fa

mily

/car

ers

who

car

e fo

r th

e pa

tien

t w

ith

liver

dis

ease

, of

fers

su

ppor

t an

d si

gnpo

sts

them

to

appr

opri

ate

agen

cies

.

• th

e em

otio

nal/

psyc

ho-s

ocia

l im

pact

of c

hron

ic

dise

ase

man

ifest

atio

n

• p

oten

tial

impa

ct o

f soc

ial d

epri

vati

on o

n he

alth

st

atus

and

live

r hea

lth

• c

olla

bora

tive

wor

king

wit

h ps

ycho

soci

al

spec

ialis

ts to

del

iver

car

e

• ri

sk p

rofil

ing

tool

s fo

r dep

ress

ion

and

anxi

ety

such

as

PhQ

9 (r

ecom

men

ded

by N

SG 9

1, N

ICE)

, CO

RE

and

HA

DS

ques

tion

nair

es

• in

terv

enti

ons,

e.g

. cog

niti

ve b

ehav

iour

al

ther

apy

(CB

T)

• m

otiv

atio

nal t

echn

ique

s

• ri

sk a

sses

smen

t for

lone

wor

ker/

sett

ing

Kno

ws

how

to:

• ta

ke a

full

com

preh

ensi

ve h

isto

ry, i

dent

ify

actu

al a

nd p

oten

tial

pro

blem

s an

d ta

ke

appr

opri

ate

acti

on

• u

nder

take

men

tal h

ealt

h an

d de

pres

sion

/anx

iety

as

sess

men

ts a

nd u

se a

sses

smen

t too

ls

• m

aint

ain

clos

e re

lati

onsh

ips

wit

h ps

ycho

soci

al

spec

ialis

ts a

nd s

ocia

l car

e se

rvic

es

• R

ole

mod

el.

• C

olla

bora

tive

.

• C

halle

nges

ass

umpt

ions

and

take

n fo

r gra

nted

way

s of

wor

king

.

• A

ctiv

e pr

omot

es b

ette

r hea

lth

fo

r pat

ient

s.

• V

alue

s le

arni

ng.

• S

tron

g cl

inic

al le

ader

ship

.

Spec

ific

• D

H, L

ong

Term

Con

ditio

ns –

Impr

ovin

g Ac

cess

to P

sych

olog

ical

The

rapi

es.

• T

he P

sych

olog

ical

Car

e of

Med

ical

P

atie

nts:

A P

ract

ical

Gui

de (2

003)

. R

epor

t of a

join

t wor

king

par

ty o

f the

R

oyal

Col

lege

of P

hysi

cian

s an

d th

e R

oyal

Col

lege

of P

sych

iatr

ists

.

• N

ICE

Gui

danc

e on

anx

iety

an

d de

pres

sion

.

• G

over

nmen

t Gui

danc

e Li

ving

Will

and

Ad

vanc

ed D

irect

ives

info

rmat

ion.

Wor

ks a

long

side

and

wit

h th

e pa

tien

t (an

d fa

mil

ies/

care

rs) t

o ad

dres

s th

e ps

ycho

logi

cal a

nd s

ocia

l im

pact

of t

heir

con

diti

on (c

onti

nued

)

6

42


Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y:7.

1 U

nder

taki

ng p

hleb

otom

y an

d ca

nnul

atio

n in

the

pati

ent w

ith

diffi

cult

acc

ess

asso

ciat

ed w

ith

thei

r li

ver

dise

ase

It is

reco

gnis

ed th

at in

som

e or

gani

sati

ons

phle

boto

my

and

cann

ulat

ions

may

be

unde

rtak

en b

y Co

mpe

tenc

e Le

vel 1

-5. T

his

com

pete

nce

spec

ifica

lly

rela

tes

to li

ver p

atie

nts

wit

h di

fficu

lt a

cces

s.7 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

6Pr

ovid

es

spec

ific

diag

nost

ic/

trea

tmen

t op

tions

saf

ely

with

rega

rds

to:

unde

rtak

ing

phle

boto

my

and

cann

ulat

ion

in th

e pa

tient

w

ith d

ifficu

lt ac

cess

as

soci

ated

w

ith th

eir l

iver

di

seas

e.

HW

B7

Core

2

Core

3

G1

a. A

sses

ses

the

clin

ical

nee

d fo

r ven

epun

ctur

e/

cann

ulat

ion

taki

ng in

to c

onsi

dera

tion

th

at p

atie

nts

wit

h liv

er d

isea

se m

ay b

e im

mun

ocom

prom

ised

or h

ave

alte

red

coag

ulop

athy

/ pe

riph

eral

oed

ema.

b. L

iste

ns a

nd re

spon

ds to

the

pati

ent’

s an

d th

eir c

arer

/fam

ily’s

sug

gest

ions

and

is s

ensi

tive

to

fam

ily/c

arer

con

cern

s (p

arti

cula

rly

whe

n th

e pa

tien

t is

a yo

ung

pers

on) a

nd a

ckno

wle

dges

th

e ad

ult a

s an

exp

ert p

atie

nt.

c. C

olla

bora

tes

wit

h th

e pa

tien

t to

iden

tify

po

ints

of v

enou

s ac

cess

.

d. Id

enti

fies

alte

rnat

ive

appr

oach

es fo

r pat

ient

s w

ith

‘poo

r acc

ess’

and

oed

ema,

and

iden

tifie

s st

rate

gies

for p

atie

nts

to ta

ke th

eir o

wn

bloo

d.

e. S

elec

ts v

ein

info

rmed

by

a ra

nge

of fa

ctor

s,

e.g.

wit

h re

gard

s to

pai

n an

d as

epsi

s.

f. Pr

epar

es p

atie

nt u

sing

com

fort

ing

and

dist

ract

ing

stra

tegi

es, e

.g. u

se o

f top

ical

an

aest

heti

c cr

eam

or s

pray

, dis

trac

tion

and

co

mfo

rt.

g. A

gree

s w

ith

the

pati

ent w

hat t

o do

if

diffi

cult

y ta

king

blo

ods

or w

ith

cann

ulat

ion,

e.

g. n

umbe

r of t

imes

to tr

y.

h. U

nder

take

s bl

ood

inve

stig

atio

ns/

cann

ulat

ion

safe

ly a

nd id

enti

fies

the

pati

ent

verb

ally

or v

ia p

atie

nt id

enti

ficat

ion

brac

elet

.

i. R

ecor

ds, o

bser

ves

and

mon

itor

s ca

nnul

a si

te.

j. Su

ppor

ts th

e pa

tien

t who

regu

larl

y ta

kes

thei

r ow

n bl

ood.

k. W

here

app

licab

le tr

ains

and

sup

ervi

ses

othe

rs in

can

nula

tion

/phl

ebot

omy

tech

niqu

es

and

care

.

l. U

nder

take

s ca

nnul

atio

n/ph

lebo

tom

y us

ing

ultr

asou

nd te

chni

ques

or v

ein

illum

inat

ion.

• p

atie

nt s

afet

y an

d co

nsen

t

• lo

cal g

uida

nce

and

polic

ies

• a

nato

my

and

phys

iolo

gy o

f art

erie

s an

d ve

ins

• d

iffer

ent t

ypes

of c

annu

lati

on/b

utte

rflie

s or

ne

edle

siz

es

• n

eedl

e st

ick

guid

ance

/pol

icie

s

• th

e im

pact

of c

onti

nued

acc

ess

to v

eins

• d

istr

acti

on te

chni

ques

• w

hen

it is

app

ropr

iate

for t

he p

atie

nt to

take

thei

r ow

n bl

ood

• th

e in

crea

sed

risk

of k

eloi

d/sc

arri

ng/i

nfec

tion

/ps

ycho

logi

cal d

istr

ess

• p

ossi

ble

com

plic

atio

ns

• a

ids

to d

ilate

ven

ous

acce

ss

• a

lter

nati

ves

to c

annu

lati

ons

for p

atie

nts

wit

h

poor

acc

ess

• n

eedl

e ph

obia

s re

lati

ng to

the

pati

ent’

s pa

st

med

ical

his

tory

• th

e tr

eatm

ent a

nd m

anag

emen

t of i

ron

ov

erlo

ad d

isea

ses

• th

eore

tica

l kno

wle

dge

requ

ired

to u

nder

take

ul

tras

ound

and

use

vei

n ill

umin

atio

n de

vice

s

• c

rite

ria,

tech

niqu

es a

nd h

azar

ds w

hen

usin

g fe

mor

al/j

ugul

ar s

tabs

for b

lood

taki

ng

• o

wn

scop

e of

pra

ctic

e an

d lim

itat

ions

.

Kno

ws

how

to:

• re

cogn

ise,

man

age

and

deal

wit

h ne

edle

pho

bias

, it

s im

pact

on

fam

ilies

and

car

ers

• re

fer t

o sp

ecia

list h

elp

whe

n re

leva

nt

• re

cogn

ise

and

act o

n co

mpl

icat

ions

and

wit

h em

erge

ncy

situ

atio

ns.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• Pa

tien

t cen

tred

and

co

mpa

ssio

nate

.

• Li

sten

s.

• U

nder

stan

ding

.

• N

on-ju

dgm

enta

l.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• Co

nfide

ntia

l.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• Pe

rson

-cen

tred

app

roac

h.

• Th

inks

cre

ativ

ely.

• D

evel

ops

trus

t.

• Pr

ovid

es c

hoic

es.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• V

alue

s ot

hers

.

• Pr

ovid

es h

igh

supp

ort a

nd h

igh

chal

leng

e.

• Em

brac

es d

iffer

ent p

ersp

ecti

ves.

• M

odel

s be

st p

ract

ice.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

an

d gu

idan

ce.

• R

CN G

astr

oint

estin

al N

ursi

ng F

orum

.

• B

ritis

h As

soci

atio

n fo

r the

Stu

dy o

f the

Li

ver N

urse

s Fo

rum

(BAS

LNF)

.

• B

ritis

h Li

ver N

urse

s Fo

rum

(BLN

F).

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth E

ngla

nd.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd

of li

fe c

are.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fro

m L

iver

D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acity

Act

200

5.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ectio

n Ac

t 199

8.

• N

HS

Choi

ces.

• N

HS

Inst

itute

for I

nnov

atio

n an

d Im

prov

emen

t.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(W

illia

ms

et a

l, 20

14)

• N

ECPO

D 2

013

Mea

surin

g th

e un

its:

a re

view

of p

atie

nts

who

die

d w

ith

alco

hol-r

elat

ed li

ver d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

ality

)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Live

r D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

43


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

(con

tinu

ed)

7Pr

ovid

es

spec

ific

diag

nost

ic/

trea

tmen

t op

tions

saf

ely

with

rega

rds

to:

unde

rtak

ing

phle

boto

my

and

cann

ulat

ion

in th

e pa

tient

w

ith d

ifficu

lt ac

cess

as

soci

ated

w

ith th

eir l

iver

di

seas

e.

HW

B7

Core

2

Core

3

G1

a. A

ccep

ts re

ferr

als

of c

ompl

ex/c

haot

ic p

atie

nts

if ap

prop

riat

e.

b. G

ains

info

rmed

con

sent

in th

e co

mpl

ex/

chao

tic

pati

ent.

c. U

nder

take

s an

d in

terp

rets

a ri

sk a

sses

smen

t fo

r the

pat

ient

.

d. U

nder

take

s ju

gula

r and

fem

oral

ve

nepu

nctu

re s

afel

y if

appr

opri

ate

acco

rdin

g to

loca

l pol

icy.

e. M

aint

ains

ow

n co

mpe

tenc

e in

thes

e pr

oced

ures

in

line

with

loca

l and

nat

iona

l gui

danc

e.

f. Tr

ains

, edu

cate

s an

d as

sess

es o

ther

hea

lth

care

pro

fess

iona

ls in

ult

raso

und

and

use

of v

ein

illum

inat

ion

devi

ces.

g. U

nder

take

s au

dit a

nd s

ervi

ce e

valu

atio

n su

ch

as c

ompl

icat

ions

and

infe

ctio

n ra

tes

or p

atie

nt

expe

rien

ce.

• a

ppro

pria

te a

sses

smen

t ski

lls

unde

rpin

ned

by re

leva

nt a

nato

my

and

phys

iolo

gy

• w

hen

it is

app

ropr

iate

to u

se ju

gula

r or

fem

oral

rout

es fo

r ven

epun

ctur

e

• th

e co

mpl

ex is

sues

that

pat

ient

s m

ay

pres

ent w

ith

• p

roto

col a

nd s

ervi

ce d

evel

opm

ent.

Kno

ws

how

to:

• c

annu

late

a p

atie

nt s

afel

y vi

a ju

gula

r or

fem

oral

ven

epun

ctur

e an

d po

ssib

le

com

plic

atio

ns

• in

terp

ret r

isk

asse

ssm

ent a

nd in

volv

es

othe

r hea

lth

care

pro

fess

iona

ls if

ap

prop

riat

e.

• C

ham

pion

s pa

tien

t-ce

ntre

d ap

proa

ch.

• R

ole

mod

el.

• V

alue

s le

arni

ng.

• C

olla

bora

tive

wor

king

acr

oss

serv

ices

.

Gen

eric

(con

tinu

ed)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fi

rst 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er in

form

atio

n an

d su

ppor

t fro

m k

ey c

hari

ties

and

org

anis

atio

ns,

such

as:

–

Bri

tish

Liv

er T

rust

– Ch

ildre

n’s

Live

r Dis

ease

Fou

ndat

ion

– A

lcoh

ol C

once

rn–

The

Hep

atit

is C

Tru

st–

Hep

atit

is B

Fou

ndat

ion

UK

– H

aem

ochr

omat

osis

Soc

iety

– W

ilson

’s D

isea

se S

uppo

rt

Gro

up (U

K)–

PBC

Foun

dati

on–

Rar

e D

isea

ses

UK

– PS

C Su

ppor

t–

Roy

al c

olle

ges,

suc

h as

, Phy

sici

ans,

Gen

eral

Pr

acti

tion

ers,

Sur

geon

s, A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er

(BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy o

f the

Liv

er

(EA

SL)

– A

mer

ican

Ass

ocia

tion

for t

he S

tudy

of L

iver

D

isea

ses

(AA

SLD

)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral a

nd E

nter

al

Nut

riti

on (B

APE

N)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Spec

ific

• N

atio

nal G

uide

lines

Cen

tre

(201

3). C

G17

4 In

trav

enou

s flu

id th

erap

y fo

r adu

lts

in h

ospi

tal.

• L

ocal

pro

toco

ls a

nd g

uide

lines

in re

lati

on to

the

man

agem

ent o

f blo

od s

pilla

ges.

(con

tinu

ed)

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.1

Und

erta

king

phl

ebot

omy

and

cann

ulat

ion

in th

e pa

tien

t wit

h di

fficu

lt a

cces

s as

soci

ated

wit

h th

eir

live

r di

seas

e (c

onti

nued

)It

is re

cogn

ised

that

in s

ome

orga

nisa

tion

s ph

lebo

tom

y an

d ca

nnul

atio

ns m

ay b

e un

dert

aken

by

Com

pete

nce

Leve

l 1 -5

. Thi

s co

mpe

tenc

e sp

ecifi

call

y re

late

s to

live

r pat

ient

s w

ith

diffi

cult

acc

ess.

7

44


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7Se

e ab

ove.

See

abov

e.Se

e ab

ove.

See

abov

e.Se

e ab

ove.

• R

CN (2

013)

Com

pete

nces

: an

educ

atio

n an

d tr

aini

ng c

ompe

tenc

e fr

amew

ork

for c

apill

ary

bloo

d sa

mpl

ing

and

vene

punc

ture

in

child

ren

and

youn

g pe

ople

.

• N

ICE

(200

2). G

uida

nce

on th

e us

e of

ult

raso

und

loca

ting

dev

ices

for

plac

ing

cent

ral v

enou

s ca

thet

ers.

TA

49.

• L

ocal

gui

danc

e on

ult

raso

und

tech

niqu

es o

r vei

n ill

umin

atio

n.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.1

Und

erta

king

phl

ebot

omy

and

cann

ulat

ion

in th

e pa

tien

t wit

h di

fficu

lt a

cces

s as

soci

ated

wit

h th

eir

live

r di

seas

e (c

onti

nued

)It

is re

cogn

ised

that

in s

ome

orga

nisa

tion

s ph

lebo

tom

y an

d ca

nnul

atio

ns m

ay b

e un

dert

aken

by

Com

pete

nce

Leve

l 1 -5

. Thi

s co

mpe

tenc

e sp

ecifi

call

y re

late

s to

live

r pat

ient

s w

ith

diffi

cult

acc

ess.

7

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.2.

Nut

riti

on a

nd fl

uid

man

agem

ent/

hydr

atio

n in

pat

ient

s w

ith

live

r di

seas

e7 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

1-4

Prov

ides

sp

ecifi

c in

terv

entio

ns

safe

ly w

ith

rega

rds

to:

nutr

ition

an

d flu

id

man

agem

ent/

hy

drat

ion

in

patie

nts

with

liv

er d

isea

se.

Core

1

HW

B7

Core

3

a. M

easu

res

and

reco

rds

wei

ght a

ccur

atel

y.

b. U

nder

take

s re

gula

r obs

erva

tion

of fl

uid

bala

nce

and

bloo

d su

gar.

c. R

ecor

ds a

ccur

atel

y flu

id b

alan

ce a

nd

nutr

itio

nal i

nput

.

d. O

bser

ves

and

reco

rds

inpu

t and

out

put.

e. R

epor

ts o

n ab

norm

al m

easu

res

to s

enio

r st

aff m

embe

r.

f. R

ecog

nise

s im

port

ance

of fl

uid

man

agem

ent/

hy

drat

ion

and

nutr

itio

n.

g. H

elps

pat

ient

s to

eat

and

dri

nk.

h. D

ocum

ents

all

obse

rvat

ions

and

ac

tion

s ac

cura

tely

.

• w

eigh

t and

BM

I

• vu

lner

abili

ty to

wei

ght a

nd m

uscl

e lo

ss b

ecau

se o

f liv

er d

isea

se

• pa

tien

t diffi

cult

ies

in m

eeti

ng n

utri

tion

al

requ

irem

ents

due

to s

ympt

oms

such

as

earl

y sa

tiet

y, n

ause

a an

d ch

ange

s in

tast

e

• ne

ed to

mon

itor

uri

ne o

utpu

t.

• or

al fl

uid

and

nutr

itio

nal i

ntak

e ta

rget

s/re

stri

ctio

ns

• w

hen

to re

port

failu

re to

mee

t nut

riti

onal

re

quir

emen

ts a

nd w

ho to

repo

rt to

.

Kno

ws

how

to:

• m

aint

ain

fluid

bal

ance

cha

rts

• ca

lcul

ate

fluid

bal

ance

on

inpu

t and

out

put

fluid

bal

ance

.

• A

war

e of

role

lim

itat

ions

and

w

hen

to o

btai

n he

lp.

• P

erso

n ce

ntre

d an

d co

mpa

ssio

nate

.

• L

iste

ns.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• C

onfid

enti

al.

• P

ride

in w

ork.

• R

espe

ctfu

l.

Gen

eric

• N

MC

docu

men

ts a

nd g

uida

nce.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

an

d gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd

of li

fe c

are.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om

Live

r Dis

ease

. Im

plic

atio

ns fo

r end

of

life

car

e.

45


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

nutr

ition

an

d flu

id

man

agem

ent/

hy

drat

ion

in

patie

nts

with

liv

er d

isea

se.

HW

B7

Core

2

Core

3

a. U

nder

take

s re

gula

r nut

riti

onal

scr

eeni

ng

usin

g ap

prop

riat

e nu

trit

iona

l too

l i.e

. MU

ST o

r ot

her l

ocal

gui

delin

e.

b. D

ocum

ents

and

revi

ews

nutr

itio

n an

d hy

drat

ion

stat

us o

n a

regu

lar b

asis

.

c. C

omm

ence

s a

food

cha

rt/d

iary

whe

n ap

prop

riat

e.

d. M

onit

ors

and

acts

on

effe

ctiv

enes

s of

nu

trit

iona

l int

erve

ntio

ns.

e. A

sses

ses

whe

ther

the

pati

ent i

s ab

le to

hy

drat

e th

emse

lves

or n

ot (c

onsi

ders

pat

ient

fo

r int

rave

nous

or n

asog

astr

ic fl

uids

).

f. Ed

ucat

es th

e pa

tien

t and

fam

ily a

bout

in

appr

opri

ate

high

sal

t foo

ds th

at s

houl

d no

t be

eat

en in

pat

ient

s w

ith

asci

tes.

g. A

sses

ses

pote

ntia

l for

refe

edin

g sy

ndro

me.

h. M

aint

ains

vig

ilanc

e w

hen

pati

ents

are

sel

f-ca

ring

(loo

king

aft

er th

emse

lves

).

i. R

efer

s to

die

titi

an in

a ti

mel

y m

anne

r and

is

able

to g

ive

the

rele

vant

nut

riti

onal

/med

ical

hi

stor

y re

quir

ed fo

r the

refe

rral

.

• n

utri

tiona

l gui

delin

es a

nd lo

cal s

cree

ning

tool

s•

nut

ritio

nal n

eeds

in p

atie

nts

with

live

r dis

ease

• re

cogn

ition

that

wei

ght/

BM

I may

not

refle

ct

the

patie

nts

nutr

ition

al s

tatu

s e.

g. m

ay s

till b

e m

alno

uris

hed

• a

war

enes

s of

inap

prop

riat

e di

etar

y re

stri

ctio

ns

such

as

low

fat o

r low

pro

tein

die

ts•

food

s hi

gh in

sal

t•

the

impo

rtan

ce o

f dai

ly w

eigh

t for

peo

ple

with

as

cite

s an

d ex

tern

al b

iliar

y dr

ains

•

und

erst

andi

ng o

f rat

iona

le fo

r use

of i

ntra

veno

us

fluid

e.g

. not

usi

ng s

alin

e so

lutio

ns fo

r peo

ple

with

asc

ites

• w

eigh

t and

wei

ght l

oss

if on

diu

retic

s•

alte

red

tast

e•

redu

ced

appe

tite

due

to a

scite

s an

d/or

jaun

dice

an

d G

I dis

turb

ance

• w

hy a

sto

ol c

hart

may

be

used

and

be

awar

e of

ch

ange

s in

bow

els

habi

ts a

ssoc

iate

d w

ith

liver

dis

ease

s•

app

ropr

iate

food

type

s an

d th

e ro

le o

f sm

all a

nd

regu

lar m

eals

(six

per

day

)•

spe

cial

die

tary

and

hyd

ratio

n re

quir

emen

ts

such

as

no a

dded

sal

t die

t, s

ip fe

eds,

vita

min

su

pple

men

tatio

n, u

se o

f flui

d re

stri

ctio

n e.

g.

hypo

natr

aem

ia, l

ate

even

ing

snac

ks•

refe

edin

g sy

ndro

me

• a

war

enes

s th

at if

pat

ient

det

oxify

ing

at ri

sk

of m

alnu

triti

on.

Kno

ws

how

to•

iden

tify

the

patie

nt a

t ris

k of

refe

edin

g sy

ndro

me.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• Su

ppor

tive

.

• En

cour

agin

g.

• Pr

ovid

es c

hoic

es.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• N

on-ju

dgm

enta

l.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

N

HS.

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(W

illia

ms

et a

l, 20

14)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a

revi

ew o

f pat

ient

s w

ho d

ied

wit

h al

coho

l-rel

ated

live

r dis

ease

, Lo

ndon

, NCE

POD

.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er

Dis

ease

: Ris

k fa

ctor

s an

d tr

eatm

ent

(fre

e ac

cess

)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is

care

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.2.

Nut

riti

on a

nd fl

uid

man

agem

ent/

hydr

atio

n in

pat

ient

s w

ith

live

r di

seas

e7

46


Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.2.

Nut

riti

on a

nd fl

uid

man

agem

ent/

hydr

atio

n in

pat

ient

s w

ith

live

r di

seas

e7 Le

vel

Com

pete

nce

KS

FP

erfo

rman

ce c

rite

ria

Kno

wle

dge

and

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s (c

onti

nued

)

6Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

nutr

ition

an

d flu

id

man

agem

ent/

hy

drat

ion

in

patie

nts

with

liv

er d

isea

se.

HW

B7

Core

2

Core

3

a. R

ecog

nise

s th

e de

teri

orat

ing

nutr

itio

nal

stat

e of

the

liver

pat

ient

.

b. A

sses

ses

and

man

ages

the

pati

ent a

t ris

k of

re

feed

ing

synd

rom

e.

c. W

orks

clo

sely

wit

h ot

her M

DT

mem

bers

suc

h as

die

titi

an, d

iabe

tes

spec

ialis

t nur

se.

d. E

stim

ates

dry

wei

ght.

e. W

orks

wit

h pa

tien

t and

fam

ily/c

arer

to

impl

emen

t and

impr

ove

nutr

itio

nal i

ntak

e w

ith

goal

set

ting

.

f. U

ses

and

eval

uate

s a

rang

e of

nut

riti

onal

and

hy

drat

ion

stra

tegi

es.

g. W

orks

wit

h th

e pa

tien

t/fa

mily

to h

elp

them

un

ders

tand

the

impo

rtan

ce fo

r ent

eral

feed

ing

desp

ite

relu

ctan

ce.

h. In

stig

ates

ent

eral

feed

ing

as p

resc

ribe

d.

i. Su

ppor

ts th

e pa

tien

t and

fam

ily/c

arer

wit

h ho

me

ente

ral f

eedi

ng if

requ

ired

as

a lo

ng te

rm

nutr

itio

nal g

oal.

• p

rote

in e

nerg

y m

alnu

trit

ion

and

effe

cts

on

liver

pat

ient

s

• s

trat

egie

s to

redu

ce p

rote

in e

nerg

y m

alnu

trit

ion

such

as

late

eve

ning

sna

cks,

hig

h fa

t sup

plem

ents

i.e

. cal

ogen

/liq

uige

n

• v

itam

in s

uppl

emen

tati

on to

add

ress

/avo

id s

uch

as o

steo

poro

sis,

per

iphe

ral n

euro

path

y

• s

teat

orrh

oea

and

its

effe

cts

on w

eigh

t los

s

• d

ry w

eigh

t and

its

impo

rtan

ce fo

r rec

ogni

sing

m

alnu

trit

ion

• ty

pes

of e

nter

al fe

edin

g su

ch a

s na

soga

stri

c,

naso

jeju

nal t

ube

if ap

prop

riat

e.

• E

mpo

wer

ing.

• D

evel

opin

g tr

ust.

• V

alue

s ot

hers

.

• V

alue

s le

arni

ng.

• R

eflec

t on

and

lear

n fr

om

own

prac

tice

.

• M

odel

s be

st p

ract

ice.

• T

hink

s cr

eati

vely

.

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Spec

ific

• N

HS

Engl

and

Not

iona

l Pat

ient

s Sa

fety

an

d Al

erts

.•

RCN

- N

utrit

ion

and

Hyd

ratio

n.•

MU

ST to

ol.

• E

SPEN

gui

delin

es.

7Pr

ovid

es

spec

ific

diag

nost

ic/

trea

tmen

t op

tions

saf

ely

with

rega

rds

to:

nutr

ition

an

d flu

id

man

agem

ent/

hy

drat

ion

in

patie

nts

with

liv

er d

isea

se.

HW

B7

Core

2

Core

3

a. U

nder

take

s a

nutr

itio

nal n

eeds

reas

sess

men

t.

b. R

ecog

nise

s an

d ac

ts u

pon

dete

rior

atin

g nu

trit

iona

l sta

tus

e.g.

pat

ient

wit

h en

d st

age

chro

nic

liver

dis

ease

.

c. S

uppo

rts

pati

ent a

nd fa

mily

/car

er w

ith

mee

ting

and

eva

luat

ing

thei

r nut

riti

onal

and

hy

drat

ion

need

s.

d. In

vest

igat

e if

requ

ired

for o

ther

cau

ses

of

wei

ght l

oss.

• c

ompl

exit

y of

nut

riti

onal

nee

ds fo

r pat

ient

s w

ith

impi

ngin

g fa

ctor

s su

ch a

s us

e of

cor

tico

ster

oids

ca

usin

g la

bile

blo

od s

ugar

s; w

eigh

t los

s du

ring

an

tivi

ral t

hera

py

Kno

ws

how

to:

• c

omm

unic

ate

effe

ctiv

ely

wit

h th

e M

DT

and

prim

ary

care

• m

onit

or p

atie

nts

on h

ome

ente

ral f

eedi

ng a

nd

goal

ach

ieve

men

t

• h

ave

com

plex

dis

cuss

ions

wit

h pa

tien

ts w

ishi

ng

to d

isco

ntin

ue e

nter

al fe

edin

g

• s

uppo

rt th

e pa

tien

t reg

ardi

ng s

tigm

a re

late

d to

ha

ving

a lo

ng te

rm n

asog

astr

ic tu

be in

sit

u.

• R

ole

mod

el.

• V

isib

le in

pra

ctic

e se

ttin

gs.

• C

ham

pion

s pa

tien

t-ce

ntre

d ap

proa

ch.

• C

olla

bora

tive

wor

king

acr

oss

serv

ices

.

• S

tron

g cl

inic

al le

ader

ship

.

47


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd

beha

viou

rs

Cont

extu

al fa

ctor

s

5Pr

ovid

es s

peci

fic

inte

rven

tions

saf

ely

with

rega

rds

to:

phar

mac

olog

ical

tr

eatm

ent a

nd s

ide-

effe

cts

Core

1

HW

B7

Core

3

a. A

sses

ses

pati

ent’

s kn

owle

dge

and

unde

rsta

ndin

g of

thei

r med

icat

ion

and

its

effe

cts.

b. P

rovi

des

pati

ent i

nfor

mat

ion

abou

t m

edic

atio

ns a

nd th

eir s

ide-

effe

cts.

c. E

nsur

es p

atie

nt is

saf

e at

all

tim

es b

y ob

serv

ing,

mon

itor

ing

and

reco

rdin

g al

l ide

ntifi

ed s

ide-

effe

cts

and

taki

ng

appr

opri

ate

acti

ons.

d. Is

ale

rt to

med

icat

ions

that

sho

uld

not b

e us

ed w

ith

peop

le w

ith

liver

dis

ease

.

e. D

ocum

ents

non

-com

plia

nce

wit

h m

edic

atio

ns w

ithi

n m

edic

al a

nd n

ursi

ng

note

s.

f. En

sure

s pr

imar

y or

sec

onda

ry c

are

prov

ider

s re

ceiv

e pa

tien

t med

icat

ion

info

rmat

ion.

• ph

arm

acol

ogic

al th

erap

ies

used

in a

cute

and

chr

onic

liv

er d

isea

se in

clud

ing:

– dos

e re

gim

e

– con

trai

ndic

atio

ns e

.g. c

ontr

acep

tion

– dru

g in

tera

ctio

ns

– sid

e ef

fect

s

– man

agem

ent/

mon

itorin

g

• c

ore

med

icat

ion

used

suc

h as

spi

rono

lact

one,

lact

ulos

e,

prop

rano

lol,

azat

hiop

rine,

pre

dnis

olon

e an

d rif

axim

in

• a

war

enes

s of

med

icat

ions

use

d in

the

prop

hyla

xis

/ se

cond

ary

prev

entio

n of

com

plic

atio

ns o

f cirr

hosi

s (s

uch

as G

I ble

ed, S

BP

and

hepa

tic e

ncep

halo

path

y) s

uch

as

prop

rano

lol,

cipr

oflox

acin

, rifa

xim

in in

line

with

loca

l an

tibio

tic p

olic

y

• m

edic

atio

ns th

at a

re c

ontr

aind

icat

ed in

live

r dis

ease

e.g

. N

SAID

s, a

spiri

n

• im

pact

of a

nalg

esia

on

cons

tipat

ion

that

can

lead

to

hepa

tic e

ncep

halo

path

y

• m

edic

atio

ns th

at le

ad to

ove

r-di

ures

is e

.g. d

iure

tics

caus

ing

rena

l im

pairm

ent /

elec

trol

yte

imba

lanc

e an

d he

patic

enc

epha

lopa

thy

• s

afe

alco

hol w

ithdr

awal

regi

me.

• m

edic

atio

ns th

at c

an p

reci

pita

te h

epat

ic

ence

phal

opat

hy; s

edat

ives

suc

h as

bar

bitu

rate

s or

be

nzod

iaze

pine

s

Kno

ws

how

to:

• re

cogn

ise

pote

ntia

l effe

cts

on th

e pa

tient

of n

on

com

plia

nce

such

as

deve

lopm

ent o

f hep

atic

en

ceph

alop

athy

, inc

reas

e in

asc

ites,

gas

troi

ntes

tinal

bl

eedi

ng.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel

of c

ompe

tenc

e, a

ble

to id

enti

fy le

arni

ng

need

s.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• S

uppo

rtiv

e.

• E

ncou

ragi

ng.

• P

rovi

des

choi

ces.

• G

ives

and

rece

ives

fe

edba

ck.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out

pati

ent c

are.

Gen

eric

•

NM

C do

cum

ents

and

gui

danc

e.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f lif

e ca

re.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om L

iver

D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a

revi

ew o

f pat

ient

s w

ho d

ied

wit

h al

coho

l-re

late

d liv

er d

isea

se,

Lond

on, N

CEPO

D.

6Pr

ovid

es s

peci

fic

inte

rven

tions

saf

ely

with

rega

rds

to:

phar

mac

olog

ical

tr

eatm

ent a

nd s

ide-

effe

cts

Core

1

HW

B7

Core

3

a. R

evie

ws

and

build

s on

und

erst

andi

ng o

f th

e pa

tien

t and

fam

ily/c

arer

and

als

o ot

her

staf

f mem

bers

wit

h re

gard

to m

edic

atio

n an

d th

e si

de e

ffec

ts.

b. W

orks

wit

h th

e ph

arm

acis

t to

prov

ide

appr

opri

ate

info

rmat

ion

and

guid

ance

to

pati

ents

and

fam

ily/c

arer

and

als

o st

aff.

c. In

vest

igat

es a

nd a

ddre

sses

reas

ons

for

non

com

plia

nce

and

refe

rs to

app

ropr

iate

M

DT

mem

bers

.

d. C

o-or

dina

tes

and

acts

as

a po

int o

f co

ntac

t reg

ardi

ng in

itia

l med

icat

ion

enqu

irie

s.

• ho

w th

e m

edic

atio

n w

orks

in re

lati

on to

und

erly

ing

path

ophy

siol

ogy

e.g.

ald

oste

rone

ant

agon

isti

c pr

oper

ties

of s

piro

nola

cton

e

• re

ason

s w

hy p

atie

nts

may

be

non-

com

plia

nt a

nd w

ho

to re

fer t

o

• th

e in

dica

tion

of i

ndiv

idua

l med

icat

ions

, whe

n to

co

ntin

ue o

r dis

cont

inue

use

and

com

mun

icat

e w

ith

appr

opri

ate

MD

T m

embe

r e.g

. pre

vent

ion

of a

ntib

ioti

c re

sist

ance

, pre

vent

ion

of W

erni

cke’

s en

ceph

alop

athy

.

Kno

ws

how

to:

• co

mm

unic

ate

wit

h th

e pa

tien

t ris

ks a

nd b

enefi

ts o

f po

ssib

le tr

eatm

ent r

egim

es.

• M

odel

s be

st p

ract

ice.

• E

mpo

wer

ing.

• W

orks

in p

artn

ersh

ip

wit

h ot

hers

.

• O

pen

to re

ceiv

ing

feed

back

.

• C

halle

nges

oth

ers

to m

aint

ain

pati

ent

safe

ty.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.3.

Pha

rmac

olog

ical

trea

tmen

t and

sid

e-ef

fect

s7

48


7P

rovi

des

spec

ific

diag

nost

ic/t

reat

men

t opt

ions

saf

ely:

(con

tinu

ed)

7.3.

Pha

rmac

olog

ical

trea

tmen

t and

sid

e-ef

fect

s (c

onti

nued

)

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd

beha

viou

rs

Cont

extu

al fa

ctor

s

7Pr

ovid

es s

peci

fic

diag

nost

ic/

trea

tmen

t opt

ions

sa

fely

with

re

gard

s to

:

phar

mac

olog

ical

tr

eatm

ent a

nd

side

-effe

cts

Core

1

HW

B7

Core

3

a. Is

an

inde

pend

ent/

supp

lem

enta

ry

non-

med

ical

pre

scrib

er (N

MP)

.

b. U

nder

take

s a

full

com

preh

ensi

ve a

sses

smen

t an

d hi

stor

y an

d in

itiat

es tr

eatm

ent a

ccor

ding

to

loca

l gui

danc

e or

pro

toco

l.

c. O

btai

ns in

form

ed c

onse

nt fr

om p

atie

nt a

nd

care

r to

pres

crib

e as

a N

MP.

d. M

onito

rs a

nd a

sses

ses

the

patie

nt’s

pro

gres

s as

app

ropr

iate

to th

e pa

tient

’s c

ondi

tion

and

the

med

icin

es p

resc

ribed

by

the

non-

med

ical

pr

escr

iber

who

m h

e/sh

e ha

s as

sess

ed fo

r car

e du

ring

the

patie

nt e

piso

de.

e. C

omm

unic

ates

with

prim

ary

and

seco

ndar

y ca

re te

ams

abou

t ini

tiatio

n or

cha

nges

in

med

icat

ions

.

f. En

sure

s pa

tient

s/ca

rer a

war

e of

how

m

edic

atio

ns w

ork,

pos

sibl

e si

de-e

ffec

ts a

nd

dura

tion

of tr

eatm

ent.

g. K

eeps

up

to d

ate

with

loca

l tru

st u

pdat

es fo

r ow

n pr

escr

ibin

g pr

actic

e.

h. P

resc

ribes

for p

eopl

e w

ith li

ver d

isea

se

with

in d

edic

ated

clin

ical

man

agem

ent p

lans

in

con

junc

tion

with

con

sulta

nt le

ads

as a

n in

depe

nden

t and

sup

plem

enta

ry n

on-m

edic

al

pres

crib

er.

i. W

orks

with

trus

t clin

ical

lead

for N

on M

edic

al

Pres

crib

ing

and

phar

mac

ist t

o de

velo

p re

leva

nt

path

way

s fo

r pre

scrib

ing

for p

atie

nts

with

live

r di

seas

e.

j. Au

dits

pre

scrib

ing

deci

sion

s an

d pr

esen

ts

year

ly d

ata

to c

linic

al fo

rum

s.

k. P

resc

ribes

for p

atie

nts

with

live

r dis

ease

w

ithin

loca

l, na

tiona

l and

inte

rnat

iona

l gu

idel

ines

.

• in

depe

nden

t/su

pple

men

tary

pre

scrib

ing

and

rela

ted

role

s an

d re

spon

sibi

litie

s

• im

prov

ing

patie

nt c

are

with

out c

ompr

omis

ing

patie

nt s

afet

y

• m

akin

g it

easi

er fo

r pat

ient

s to

get

the

med

icat

ion

they

nee

d

• in

crea

se p

atie

nt c

hoic

e in

acc

essi

ng m

edic

ines

• m

akin

g be

tter

use

of t

he s

kills

of h

ealth

pro

fess

iona

ls

• c

ontr

ibut

e to

the

intr

oduc

tion

of m

ore

flexi

ble

team

w

orki

ng a

cros

s th

e N

HS

• c

onse

quen

ces

of n

on c

ompl

ianc

e w

ith m

edic

atio

n fo

r pat

ient

s w

ith H

epat

itis

C e.

g. p

ossi

ble

futu

re

resi

stan

ce to

dru

gs

• lo

cal a

nd n

atio

nal p

resc

ribin

g gu

idel

ines

rele

vant

to

role

• ro

les

and

resp

onsi

bilit

ies

of th

e N

MP

in re

latio

n to

th

eir o

wn

pres

crib

ing

prac

tice

with

in th

eir r

ole

e.g.

a

non-

med

ical

pre

scrib

er c

an o

nly

orde

r a d

rug

for

a pa

tient

who

m h

e/sh

e ha

s as

sess

ed fo

r car

e du

ring

the

patie

nt e

piso

de.

• th

at in

depe

nden

t pre

scrib

ers

mus

t not

pre

scrib

e an

y m

edic

ine

for t

hem

selv

es. N

eith

er s

houl

d th

ey

pres

crib

e a

med

icin

e fo

r any

one

with

who

m th

ey

have

a c

lose

per

sona

l or e

mot

iona

l rel

atio

nshi

p,

othe

r tha

n in

an

exce

ptio

nal c

ircum

stan

ce.

• le

gal a

nd e

thic

al a

spec

ts o

f pre

scrib

ing.

Kno

ws

how

to:

• o

btai

n up

to d

ate

know

ledg

e ab

out s

afet

y of

m

edic

ines

• p

resc

ribe

safe

ly a

nd w

ithin

the

boun

ds o

f ind

ivid

ual

NM

P ro

le

• re

cogn

ise

his

or h

er o

wn

limita

tions

/com

pete

nces

an

d to

refe

r to

the

appr

opria

te m

edic

al d

octo

r for

as

sess

men

t or p

resc

ribin

g ou

tsid

e hi

s/he

r lev

el o

f pr

actic

e or

exp

ertis

e

• b

e re

view

ed fo

r com

pete

nce

thro

ugh

Know

ledg

e an

d Sk

ills

Fram

ewor

k (K

SF) a

nd a

nnua

l app

rais

al

proc

ess

• n

otify

the

Med

icin

es a

nd H

ealth

Car

e Pr

oduc

ts

Regu

lato

ry A

genc

y vi

a th

e AD

R Re

port

ing

Sche

me

in

the

even

t of a

ny a

dver

se re

actio

n to

med

icat

ion.

• A

tten

tion

to d

etai

l.

• R

ole

mod

el.

• C

halle

nges

oth

ers.

• L

earn

ing

from

ow

n pr

acti

ce.

• A

ctiv

e le

arne

r.

• D

evel

ops

trus

t.

• A

ctiv

ely

prom

otes

be

tter

hea

lth

for

pati

ents

.

• C

halle

nges

as

sum

ptio

ns a

nd ta

ken

for g

rant

ed w

ays

of

wor

king

.

• V

igila

nce.

Gen

eric

(con

tinu

ed)

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se:

Ris

k fa

ctor

s an

d tr

eatm

ent (

free

acc

ess)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

cha

riti

es

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy o

f Li

ver D

isea

ses

(AA

SLD

)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral a

nd

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

(cur

rent

ly u

nder

revi

ew).

– Gen

eral

Pha

rmac

euti

cal C

ounc

il (2

012)

The

st

anda

rds,

eth

ics

and

perf

orm

ance

49


7P

rovi

des

spec

ific

diag

nost

ic/t

reat

men

t opt

ions

saf

ely:

(con

tinu

ed)

7.3.

Pha

rmac

olog

ical

trea

tmen

t and

sid

e-ef

fect

s (c

onti

nued

)

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

8Pr

ovid

es s

peci

fic

inte

rven

tions

sa

fely

with

re

gard

s to

:

phar

mac

olog

ical

tr

eatm

ent a

nd

side

-effe

cts

Core

1

HW

B7

Core

3

a. Is

an

inde

pend

ent/

supp

lem

enta

ry n

on-

med

ical

pre

scrib

er.

b. P

resc

ribes

for p

atie

nts

with

live

r dis

ease

and

a

rang

e of

clin

ical

pro

blem

s, s

uch

as, d

iabe

tes

and

hype

rten

sion

.

c. P

rovi

des

clin

ical

sup

ervi

sion

to n

ew N

MP.

d. Id

entifi

es g

aps

in th

e se

rvic

e w

here

NM

P w

ill

impr

ove

patie

nt q

ualit

y.

e. W

orks

acr

oss

sect

ors

and

deve

lop

outr

each

se

rvic

es.

f. D

evel

ops

and

lead

s im

plem

enta

tion

of N

MP

to

impr

ove

patie

nt a

cces

s to

a q

ualit

y se

rvic

e.

• th

e im

pact

of a

rang

e of

clin

ical

pro

blem

s, s

uch

as,

diab

etes

and

hyp

erte

nsio

n on

pre

scrib

ing

prac

tice

• m

anag

ing

the

patie

nt w

ith c

ompl

ex c

o-m

orbi

ditie

s.

Kno

ws

how

to:

• p

resc

ribe

safe

ly fo

r peo

ple

with

live

r dis

ease

and

as

soci

ated

clin

ical

pro

blem

s.

• S

tron

g cl

inic

al le

ader

ship

.

• C

olla

bora

tive

wor

king

acr

oss

serv

ices

.

• C

ham

pion

s pe

rson

-cen

tred

ap

proa

ch.

• P

assi

onat

e ab

out p

atie

nt s

afet

y.

Spec

ific

• N

MC

(201

5) T

he C

ode.

• N

MC

(201

0) S

tand

ards

for

Med

icin

es M

anag

emen

t.

• N

ICE

Gui

danc

e fo

r Hep

atit

is B

and

C

Trea

tmen

t.

• L

ocal

gui

delin

es a

nd p

roto

cols

.

• N

on-M

edic

al p

resc

ribi

ng.

• U

nive

rsit

y of

Liv

erpo

ol C

entr

e fo

r D

rug

Safe

ty a

nd S

cien

ce

– MH

RA

web

site

ale

rtin

g se

rvic

e

– NM

C (2

006)

Sta

ndar

ds o

f P

rofic

ienc

y fo

r Nur

se a

nd

Mid

wiv

es P

resc

ribe

rs

(c

urre

ntly

und

er re

view

).

– G

ener

al P

harm

aceu

tica

l Cou

ncil

(201

2) T

he s

tand

ards

, eth

ics

and

perf

orm

ance

– NIC

E m

edic

ines

and

pre

scri

bing

– Dep

artm

ent o

f Hea

lth

(Apr

il 20

06) I

mpr

ovin

g P

atie

nts’

A

cces

s to

Med

icin

es: A

Gui

de

to Im

plem

enti

ng N

urse

and

P

harm

acis

t Ind

epen

dent

P

resc

ribi

ng w

ithi

n th

e N

HS

In

Engl

and

(arc

hive

d bu

t ava

ilabl

e).

50


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

non-

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns

Core

1

HW

B7

Core

3

a. C

omm

unic

ates

eff

ectiv

ely

with

the

indi

vidu

al

rega

rdin

g th

e ne

ed fo

r non

inva

sive

live

r scr

een

(NIL

S) te

stin

g.

b. E

xpla

ins

to p

atie

nts

othe

r non

-inva

sive

ap

proa

ches

that

may

be

used

.

c. P

repa

res

patie

nts

and

thei

r fam

ilies

for n

on-

inva

sive

dia

gnos

tics

and

wha

t to

expe

ct.

d. E

nsur

es fo

llow

-up

in p

lace

with

lead

clin

icia

n or

GP

for d

iscu

ssio

n of

resu

lts.

e. D

ocum

ents

cle

ar a

nd a

ccur

ate

info

rmat

ion

rela

ting

to in

vest

igat

ions

requ

este

d in

line

with

lo

cal p

olic

y.

• no

n-in

vasi

ve li

ver s

cree

ning

suc

h as

blo

od

anal

ysis

, ult

raso

und

scan

ning

and

Fib

rosc

an

• un

ders

tand

s th

e ra

nge

of b

lood

test

s w

ithi

n a

non-

inva

sive

live

r scr

een

• de

mon

stra

tes

know

ledg

e of

bas

ic li

ver c

ondi

tion

s an

d ke

y sp

ecia

list i

nter

vent

ions

• no

rmal

par

amet

ers

of a

non

-inva

sive

live

r scr

een.

Kno

ws

how

to:

• ac

cess

furt

her s

uppo

rt a

nd e

xper

tise

to a

llay

pati

ents

fear

s an

d an

xiet

ies.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• S

uppo

rtiv

e.

• E

ncou

ragi

ng.

• P

rovi

des

choi

ces.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• F

lexi

ble.

• N

on-ju

dgm

enta

l.

• P

assi

onat

e ab

out p

atie

nt c

are.

• P

atie

nt c

entr

ed a

nd

com

pass

iona

te.

• L

iste

ns.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• C

onfid

enti

al.

Gen

eric

•

NM

C do

cum

ents

and

gui

danc

e.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

an

d gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd

of li

fe c

are.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om L

iver

D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

N

HS

.

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al

, 201

4)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a

revi

ew o

f pat

ient

s w

ho d

ied

wit

h al

coho

l-rel

ated

live

r dis

ease

, Lon

don,

N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

6Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

non-

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns

HW

B7

Core

2

Core

3

a. E

xpla

ins

the

outc

omes

of n

on-in

vasi

ve

diag

nost

ics

to p

atie

nts

and

fam

ilies

.

b. A

cts

upon

resu

lts a

nd in

itiat

es, i

mpl

emen

ts

and

eval

uate

s se

lect

ed in

terv

entio

ns, e

.g. h

ealth

ad

vice

rega

rdin

g N

AFLD

.

c. R

efer

s to

app

ropr

iate

hea

lth c

are

pers

onne

l.

d. E

stab

lishe

s ra

ppor

t and

is a

ble

to s

uppo

rt th

e pa

tient

with

com

plex

and

pot

entia

lly s

tres

sful

di

agno

sis

and

trea

tmen

ts in

a ra

nge

of s

ituat

ions

.

e. D

iscu

sses

pot

entia

l diff

eren

tial d

iagn

oses

.

• lim

itat

ions

of N

ILS

and

advi

ses

on th

e po

ssib

ility

of

futu

re te

sts

• liv

er c

ondi

tion

s, k

ey s

peci

alis

t int

erve

ntio

ns a

nd

ther

apie

s ap

prop

riat

e to

the

liver

pat

ient

• no

rmal

and

abn

orm

al re

sult

s

• di

ffer

enti

al d

iagn

oses

• lo

cal c

are

path

way

s.

Kno

ws

how

to:

• re

fer t

o re

leva

nt h

ealt

h ca

re p

rofe

ssio

nals

suc

h as

liv

er s

peci

alis

t tea

ms,

die

titi

an, a

lcoh

ol s

ervi

ces

• ac

cess

oth

er in

terf

acin

g se

rvic

es s

uch

as d

iabe

tes,

ca

rdio

logy

.

• M

odel

s be

st p

ract

ice.

• E

mpo

wer

ing.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• O

pen

to re

ceiv

ing

feed

back

.

• C

halle

nges

oth

ers

to m

aint

ain

pati

ent s

afet

y.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.4.

Non

-inv

asiv

e di

agno

stic

s an

d tr

eatm

ent o

ptio

ns

7

51


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd

beha

viou

rs

Cont

extu

al fa

ctor

s

7Pr

ovid

es

spec

ific

diag

nost

ic/

trea

tmen

t op

tions

saf

ely

with

rega

rds

to:

non-

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns.

HW

B7

Core

2

Core

3

G1

a. P

rovi

des

and

rece

ives

hig

hly

com

plex

, se

nsiti

ve o

r con

tent

ious

info

rmat

ion.

b. C

omm

unic

ates

ver

y se

nsiti

ve, c

ompl

ex

cond

ition

rela

ted

info

rmat

ion

to p

atie

nts,

re

lativ

es w

ith e

mpa

thy

and

reas

sura

nce.

c. R

efer

s ap

prop

riate

ly fo

llow

ing

diag

nosi

s,

for f

urth

er h

aem

atol

ogic

al, b

ioch

emic

al,

viro

logy

and

gen

etic

test

ing

acro

ss a

rang

e of

liv

er d

isor

ders

suc

h as

abd

omin

al u

ltras

ound

, co

mpu

teris

ed to

mog

raph

y/m

agne

tic re

sona

nce

scan

with

in o

wn

scop

e of

pro

fess

iona

l pra

ctic

e.

d. In

itiat

es ti

mel

y an

d ap

prop

riate

con

sulta

tion,

re

ferr

als

and

colla

bora

tion

with

oth

er h

ealth

ca

re p

rovi

ders

.

e. A

ccep

ts d

irect

refe

rral

s/de

velo

ps c

are

path

way

s ac

ross

prim

ary/

seco

ndar

y ca

re.

• cl

inic

al p

athw

ays

for t

reat

men

t e.g

. hep

atit

is C

, he

pati

tis

B, a

lcoh

ol, o

besi

ty

• in

itia

tion

and

mon

itor

ing

of s

peci

fic tr

eatm

ents

• co

mm

unic

atin

g co

mpl

ex a

nd p

oten

tial

ly s

ensi

tive

in

form

atio

n

• a

rang

e of

live

r dis

ease

s at

a h

ighl

y de

velo

ped

leve

l tha

t inc

orpo

rate

s ev

iden

ce b

ase

and

expe

rien

ce

• th

e ro

le o

f non

med

ical

pre

scri

bing

to d

eliv

er

qual

ity

care

in b

oth

prim

ary

and

seco

ndar

y se

ttin

g.

Kno

ws

how

to:

• in

terp

ret c

ompl

ex re

sult

s an

d in

vest

igat

ions

.

• A

tten

tion

to d

etai

l.

• R

ole

mod

el.

• Ch

alle

nges

oth

ers.

• Le

arni

ng fr

om o

wn

prac

tice

.

• A

ctiv

e le

arne

r.

• D

evel

ops

trus

t.

• A

ctiv

ely

prom

otes

bet

ter

heal

th fo

r pat

ient

s.

• Ch

alle

nges

ass

umpt

ions

an

d ta

ken

for g

rant

ed w

ays

of w

orki

ng.

• V

igila

nce.

Gen

eric

(con

tinu

ed)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er D

isea

se:

Ris

k fa

ctor

s an

d tr

eatm

ent (

free

acc

ess)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

cha

riti

es

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy o

f Li

ver D

isea

ses

(AA

SLD

)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral a

nd

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Spec

ific

• Lo

cal p

olic

ies.

8Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

non-

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns.

HW

B7

Core

2

Core

3

G1

a. C

o-or

dina

tes

and

deliv

ers

seam

less

car

e an

d pr

ovid

ing

appr

opria

te s

hort

and

long

term

fo

llow

up

follo

win

g no

n-in

vasi

ve d

iagn

ostic

s an

d tr

eatm

ents

.

b. A

ble

to w

ork

inde

pend

ently

as

the

clin

ical

le

ad in

eith

er p

rimar

y or

sec

onda

ry c

are.

c. In

itiat

es a

udit

to re

view

pat

ient

and

car

ers

expe

rienc

e of

spe

cific

inve

ntio

ns, p

athw

ays

and

serv

ices

.

d. W

orks

with

com

mis

sion

ers

to id

entif

y lo

cal a

nd s

trat

egic

nee

ds fo

r dev

elop

ing

care

pa

thw

ays

with

in li

ver s

ervi

ces.

• au

dit a

nd re

sear

ch

• co

ntem

pora

ry e

vide

nce

base

• lo

cal c

omm

issi

onin

g ar

rang

emen

ts

• ne

w tr

eatm

ent o

ptio

ns fo

r liv

er d

isea

se

• w

orki

ng in

an

outr

each

role

to d

eliv

er li

ver

serv

ices

.

• S

tron

g cl

inic

al le

ader

ship

.

• C

olla

bora

tive

wor

king

ac

ross

ser

vice

s.

• C

ham

pion

s pe

rson

cen

tred

ap

proa

ch.

• P

assi

onat

e ab

out p

atie

nt

safe

ty.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.4.

Non

-inv

asiv

e di

agno

stic

s an

d tr

eatm

ent o

ptio

ns

7

52


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns

Core

1

HW

B7

Core

3

a. E

xpla

ins

to p

atie

nt th

e di

ffer

ent i

nvas

ive

appr

oach

es, p

ossi

ble

side

eff

ects

and

co

mpl

icat

ions

.

b. A

nsw

ers

patie

nts

ques

tions

or i

f una

ble

to th

en a

cces

s in

form

atio

n fr

om a

ppro

pria

te

othe

rs.

c. P

repa

res

patie

nts

for i

nvas

ive

proc

edur

es.

d. M

onito

rs p

atie

nts

follo

win

g in

vasi

ve

proc

edur

es fo

r sid

e-ef

fect

s or

com

plic

atio

ns.

e. D

ocum

ents

all

obse

rvat

ions

and

act

ions

ac

cura

tely

.

• no

rmal

ana

tom

y an

d ph

ysio

logy

of t

he li

ver a

nd

bilia

ry s

yste

m

• in

vasi

ve a

ppro

ache

s to

live

r inv

esti

gati

ons

and

trea

tmen

ts, i

nclu

ding

:

– end

osco

py

– end

osco

pic

retr

ogra

de

chol

angi

opan

cret

ogra

phy

(ER

CP)

– ext

erna

l bili

ary

drai

n

– end

osco

pic

ultr

asou

nd

– liv

er b

iops

y

– par

acen

tesi

s

– tra

nsju

gula

r int

rahe

pati

c po

rtos

yste

mic

shu

nt

(TIP

S)

– tra

nsar

teri

al c

hem

oem

bolis

atio

n (T

ACE

) rad

io

freq

uenc

y ab

lati

on (R

FA)

– the

gen

eral

sid

e ef

fect

s of

inva

sive

inte

rven

tion

s su

ch a

s; h

ypov

olae

mic

sho

ck, p

ain,

sep

sis,

ac

ute

kidn

ey in

jury

– pl

eure

x dr

ains

.

Kno

ws

how

to:

• re

cogn

ise

and

act o

n co

mpl

icat

ions

follo

win

g th

e ab

ove

proc

edur

es.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• Su

ppor

tive

.

• En

cour

agin

g.

• Pr

ovid

es c

hoic

es.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• N

on-ju

dgm

enta

l.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

• Pa

tien

t cen

tred

and

co

mpa

ssio

nate

.

• Li

sten

s.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• Co

nfide

ntia

l.

• Pa

tien

t saf

ety.

Gen

eric

•

NM

C do

cum

ents

and

gui

danc

e.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

and

gu

idan

ce.

• R

CN G

astr

oint

esti

nal N

ursi

ng F

orum

.

• B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver N

urse

s Fo

rum

(BA

SLN

F).

• B

riti

sh L

iver

Nur

ses

Foru

m (B

LNF)

.

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth

Engl

and.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd o

f lif

e ca

re.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fr

om L

iver

D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acit

y A

ct 2

005.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ecti

on A

ct 1

998.

• N

HS

Choi

ces.

• N

HS

Inst

itut

e fo

r Inn

ovat

ion

and

Impr

ovem

ent.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

suri

ng th

e un

its:

a

revi

ew o

f pat

ient

s w

ho d

ied

wit

h al

coho

l-re

late

d liv

er d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

alit

y)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Liv

er

Dis

ease

: Ris

k fa

ctor

s an

d tr

eatm

ent (

free

ac

cess

)

(con

tinu

ed)

6Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns

HW

B7

Core

2

Core

3

a. E

xpla

ins

to p

atie

nt a

nd c

arer

s tr

eatm

ent

crite

ria a

nd p

roto

cols

.

b. D

evel

ops

and

eval

uate

s ap

prop

riate

car

e m

anag

emen

t pla

n fo

llow

ing

ther

apeu

tic

inte

rven

tion.

c. G

ives

pat

ient

and

car

ers

advi

ce o

n fo

llow

up

and

on-g

oing

and

futu

re c

are

requ

irem

ents

.

d. S

ignp

osts

pat

ient

s an

d ca

rers

to o

ther

ca

re o

ptio

ns s

uch

as c

omm

unity

pal

liativ

e ca

re.

e. D

evel

ops,

in c

onju

nctio

n w

ith o

ther

hea

lth

care

pro

fess

iona

ls, a

man

agem

ent p

lan

for

refu

sal o

f tre

atm

ent.

• bi

liary

com

plic

atio

ns a

nd c

hola

ngit

is

• liv

er d

isea

se, c

o-m

orbi

diti

es a

nd th

e im

pact

on

trea

tmen

t out

com

es e

.g. c

irrh

osis

/fibr

osis

• flu

id re

plac

emen

t pro

toco

ls in

par

acen

tesi

s

• ra

tion

ale

for T

IPS

in e

mer

genc

y an

d th

erap

euti

c si

tuat

ions

• po

ssib

le c

ompl

icat

ions

of T

IPS

and

man

agem

ents

op

tion

s

• di

ffer

ent t

hera

peut

ic o

ptio

ns th

eir s

tren

gths

, w

eakn

esse

s an

d si

de-e

ffec

t

• si

de e

ffec

ts o

f tre

atm

ents

suc

h as

tran

sart

eria

l ch

emoe

mbo

lisat

ion

(TA

CE),

radi

o fr

eque

ncy

abla

tion

(RFA

), o

ther

new

trea

tmen

ts b

eing

use

d in

diff

eren

t liv

er c

entr

es.

• M

odel

s be

st p

ract

ice.

• Em

pow

erin

g.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• O

pen

to re

ceiv

ing

feed

back

.

• Ch

alle

nges

oth

ers

to m

aint

ain

pati

ent s

afet

y.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.5

Inva

sive

dia

gnos

tics

and

trea

tmen

t opt

ions

7

53


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd

beha

viou

rs

Cont

extu

al fa

ctor

s

6K

now

s ho

w to

:•

inte

rpre

t res

ults

in c

onju

ncti

on w

ith

othe

r hea

lth

care

pro

fess

iona

ls

• g

ive

rele

vant

info

rmat

ion

and

advi

ce fo

llow

ing

trea

tmen

t int

erve

ntio

n

• in

volv

e re

leva

nt p

rim

ary

care

hea

lth

prof

essi

onal

s.

Gen

eric

(con

tinu

ed)

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is c

are

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

cha

riti

es

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy o

f the

Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy o

f Liv

er

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral a

nd

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

7Pr

ovid

es

spec

ific

diag

nost

ic/

trea

tmen

t op

tions

saf

ely

with

rega

rds

to:

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns.

HW

B7

Core

2

Core

3

G1

a. R

evie

ws

with

the

patie

nt a

nd c

arer

pos

sibl

e th

erap

eutic

opt

ions

.

b. A

sses

ses

effe

ctiv

enes

s of

the

trea

tmen

t op

tions

.

c. P

rovi

des

in-d

epth

info

rmat

ion

to p

atie

nt

and

care

rs a

bout

ther

apeu

tic tr

eatm

ents

and

op

tions

.

d. E

valu

ates

eff

ectiv

enes

s of

the

care

m

anag

emen

t pla

n.

e. W

orks

with

oth

er h

ealth

car

e pr

ofes

sion

al to

pr

ovid

e on

-goi

ng fo

llow

up

and

care

.

f. D

iscu

sses

rele

vant

trea

tmen

t opt

ions

with

pa

tient

and

car

ers

such

as

refe

rral

to p

allia

tive

care

ser

vice

s.

g. W

orks

acr

oss

prim

ary

and

seco

ndar

y ca

re to

co

-ord

inat

e ap

prop

riate

/spe

cific

car

e pa

thw

ay.

• p

urpo

se a

nd c

rite

ria

for e

ach

inte

rven

tion

• s

ide-

effe

cts/

com

plic

atio

ns a

nd h

ow th

ey s

houl

d be

man

aged

of:

– end

osco

py

–ER

CP

– ext

erna

l bili

ary

drai

n

– end

osco

pic

ultr

asou

nd

– liv

er b

iops

y

– par

acen

tesi

s

– tra

nsju

gula

r int

rahe

pati

c po

rtos

yste

mic

shu

nt

(TIP

S)

– TA

CE/R

FA

• cr

iter

ia fo

r inv

asiv

e liv

er ri

sk p

rofil

ing

and

whe

ther

th

e re

sult

s w

ill c

hang

e pa

tien

t man

agem

ent e

.g.

man

agem

ent o

f Non

Alc

ohol

ic F

atty

Liv

er D

isea

se

(NA

FLD

) in

prim

ary

and

seco

ndar

y ca

re

• ro

le o

f inv

asiv

e ri

sk p

rofil

ing

in re

lati

on to

mak

ing

a di

agno

sis

or a

sses

smen

t for

trea

tmen

t suc

h as

liv

er tr

ansp

lant

.

Kno

ws

how

to:

• in

terp

ret c

ompl

ex re

sult

s an

d in

vest

igat

ions

• re

fer t

o re

leva

nt s

peci

alis

t.

• P

atie

nt s

afet

y.

• A

tten

tion

to d

etai

l.

• R

ole

mod

el.

• C

halle

nges

oth

ers.

• L

earn

ing

from

ow

n pr

acti

ce.

• A

ctiv

e le

arne

r.

• D

evel

ops

trus

t.

• A

ctiv

ely

prom

otes

bet

ter

heal

th fo

r pat

ient

s.

• C

halle

nges

ass

umpt

ions

an

d ta

ken

for g

rant

ed

way

s of

wor

king

.

• V

igila

nce.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.5

Inva

sive

dia

gnos

tics

and

trea

tmen

t opt

ions

7

54


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

8Pr

ovid

es

spec

ific

inte

rven

tions

sa

fely

with

re

gard

s to

:

inva

sive

di

agno

stic

s an

d tr

eatm

ent

optio

ns.

HW

B7

Core

2

Core

3

G1

a. U

nder

take

s a

full

com

preh

ensi

ve a

sses

smen

t an

d hi

stor

y an

d in

itiat

es tr

eatm

ent a

ccor

ding

to

loca

l gui

danc

e or

pro

toco

l.

b. E

nsur

es c

linic

al ju

stifi

catio

n of

the

exam

inat

ion

requ

est a

nd a

ppro

pria

te in

dica

tion

for p

roce

dure

, ass

essi

ng a

ny c

ontr

aind

icat

ions

.

c. U

nder

take

s th

e fo

llow

ing

proc

edur

es

safe

ly w

ithin

agr

eed

com

pete

nce

limits

and

or

gani

satio

nal p

roto

cols

:

– pa

race

ntes

is

– liv

er b

iops

y

– en

dosc

opy.

d. E

valu

ate

the

effe

ctiv

enes

s of

the

inte

rven

tion

and

need

for f

urth

er in

terv

entio

n.

e. T

akes

app

ropr

iate

act

ion

in th

e ev

ent o

f co

mpl

icat

ions

and

liai

ses

with

med

ical

team

as

requ

ired.

f. En

sure

s sa

fe d

isch

arge

of t

he p

atie

nt w

ith

agre

ed fo

llow

up

for d

iscu

ssio

n of

resu

lts.

g. P

rovi

des

advi

ce o

n ne

ed fo

r fut

ure

trea

tmen

t op

tions

.

h. L

iais

es w

ith a

ppro

pria

te m

edic

al te

am o

r ot

her h

ealth

car

e pr

ofes

sion

als.

• in

-dep

th a

nato

my,

phy

siol

ogy

and

path

olog

y in

re

lati

on to

the

ther

apeu

tic

opti

on:

– par

acen

tesi

s

– liv

er b

iops

y

– end

osco

py

• bo

unda

ries

of c

ompe

tenc

e an

d ho

w to

kee

p th

is

up to

dat

e

• in

form

ed c

onse

nt a

nd le

gal i

mpl

icat

ions

• m

orbi

dity

and

mor

talit

y ri

sks

asso

ciat

ed w

ith

the

abov

e pr

oced

ures

and

how

thes

e ca

n be

m

inim

ised

and

reco

gnis

ed.

Kno

ws

how

to:

• ob

tain

info

rmed

con

sent

• en

sure

pat

ient

par

amet

ers

prio

r to

proc

edur

es a

re

wit

hin

agre

ed li

mit

s

• sa

fely

ope

rate

ult

raso

und

mac

hine

in li

ne w

ith

loca

l pol

ices

• re

cogn

ise

abno

rmal

ana

tom

y su

ch a

s bi

liary

ob

stru

ctio

n an

d fo

cal a

bnor

mal

itie

s.

• un

dert

ake

proc

edur

es s

afel

y an

d ac

cord

ing

to

prot

ocol

s

• re

cogn

ises

and

act

on

side

eff

ects

and

co

mpl

icat

ions

• in

terp

ret r

esul

ts a

nd c

omm

unic

ates

to o

ther

s

• do

cum

ent p

roce

dure

s co

rrec

tly

and

com

mun

icat

es to

pat

ient

and

gen

eral

pra

ctit

ione

r

• pa

rtic

ipat

e in

pee

r rev

iew

.

• St

rong

clin

ical

lead

ersh

ip.

• Co

llabo

rati

ve w

orki

ng a

cros

s se

rvic

es.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

.

• Pa

ssio

nate

abo

ut p

atie

nt s

afet

y.

Spec

ific

• L

ocal

pro

toco

ls a

nd p

atie

nt p

athw

ays.

• B

SG G

uida

nce

on L

iver

Bio

psy

(200

4).

• U

pper

GI B

leed

ing

(201

5).

• A

ASL

D g

uide

lines

: asc

ites

due

to

cirr

hosi

s an

d da

te (2

012)

and

live

r bi

opsy

(201

4).

• E

ASL

clin

ical

pra

ctic

e gu

idel

ines

on

the

man

agem

ent o

f asc

ites

, sp

onta

neou

s ba

cter

ial p

erit

onit

is a

nd

hepa

tore

nal s

yndr

ome

in c

irrh

osis

.

• Jo

int A

dvis

ory

Gro

up fo

r GI

Endo

scop

y.

• R

CN (2

012)

Adv

ance

d N

urse

pr

acti

tion

er a

nd R

CN G

uide

to

adva

nced

nur

sing

pra

ctic

e, a

dvan

ced

nurs

e pr

acti

tion

er a

nd p

rogr

amm

e ac

cred

itat

ion.

• N

ICE

guid

ance

on

liver

con

diti

ons

and

trea

tmen

ts.

Pro

vide

s sp

ecifi

c di

agno

stic

/tre

atm

ent o

ptio

ns s

afel

y: (c

onti

nued

)

7.5

Inva

sive

dia

gnos

tics

and

trea

tmen

t opt

ions

7N

urse

s op

erat

ing

at th

is le

vel w

ill n

eed

to h

ave

rece

ived

app

ropr

iate

inte

rven

tion

al tr

aini

ng a

nd a

sses

sed

com

pete

nce

as d

efine

d by

thei

r or

gani

sati

on.

55


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

1-4

Use

s ea

rly

war

ning

tool

s/

appr

oach

es

(suc

h as

re

d al

ert)

to

iden

tify

the

patie

nt’s

ch

angi

ng a

nd

dete

rior

atin

g co

nditi

on,

and

take

s ap

prop

riat

e ac

tion.

HW

B2

HW

B3

Core

3

a. A

sses

ses

patie

nt’s

wel

l-bei

ng.

b. U

nder

take

s cl

inic

al o

bser

vatio

ns a

nd

docu

men

ts in

app

ropr

iate

pla

ce.

c. U

ses

early

war

ning

tool

s to

pic

k up

cha

nges

an

d de

terio

ratio

n.

d. R

epor

ts a

ll fin

ding

s to

qua

lified

nur

sing

sta

ff.

e. R

espo

nds

appr

opria

tely

to c

once

rns

rais

ed.

• th

e si

gnifi

canc

e of

per

form

ing

clin

ical

ob

serv

atio

ns o

n pa

tien

ts w

ith

liver

dis

ease

• ea

rly

war

ning

tool

s (b

asic

kno

wle

dge)

• w

ho to

rais

e co

ncer

ns w

ith

e.g.

whe

n re

ceiv

ing

verb

al c

ompl

aint

s or

any

phy

sica

l cha

nges

in

cond

itio

n or

oth

er in

cide

nts.

Kno

ws

how

to:

• re

port

any

cha

nges

in th

e pa

tien

t tha

t mig

ht le

ad

to d

eter

iora

tion

in th

eir c

ondi

tion

.

• A

war

e of

role

lim

itat

ions

and

w

hen

to o

btai

n he

lp.

• Pe

rson

-cen

tred

and

co

mpa

ssio

nate

.

• Li

sten

s.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• Co

nfide

ntia

l.

• Pr

ide

in w

ork.

• R

espe

ctfu

l.

Gen

eric

•

NM

C do

cum

ents

and

gui

danc

e.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

an

d gu

idan

ce.

• R

CN G

astr

oint

estin

al N

ursi

ng F

orum

.

• B

ritis

h As

soci

atio

n fo

r the

Stu

dy o

f the

Li

ver N

urse

s Fo

rum

(BAS

LNF)

.

• B

ritis

h Li

ver N

urse

s Fo

rum

(BLN

F).

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth E

ngla

nd.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd

of li

fe c

are.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fro

m L

iver

D

isea

se. I

mpl

icat

ions

for e

nd o

f life

ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acity

Act

200

5.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ectio

n Ac

t 199

8.

• N

HS

Choi

ces.

• N

HS

Inst

itute

for I

nnov

atio

n an

d Im

prov

emen

t.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

surin

g th

e un

its:

a re

view

of p

atie

nts

who

die

d w

ith

alco

hol-r

elat

ed li

ver d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

ality

)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Live

r D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

(con

tinue

d)

5U

ses

earl

y w

arni

ng to

ols/

ap

proa

ches

(s

uch

as

red

aler

t) to

id

entif

y th

e pa

tient

’s

chan

ging

and

de

teri

orat

ing

cond

ition

, an

d ta

kes

appr

opri

ate

actio

n.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. U

ses

the

loca

l ear

ly w

arni

ng to

ol to

asc

erta

in

chan

ges

in v

ital s

igns

and

oth

er in

dica

tors

of

det

erio

ratio

n fr

om c

ompl

icat

ions

of l

iver

di

seas

e or

follo

win

g in

vasi

ve p

roce

dure

s an

d/or

tr

ansp

lant

atio

n.

b. A

sses

ses

the

patie

nt fo

r the

abo

ve

com

plic

atio

ns.

c. D

ocum

ents

, mon

itors

and

act

s on

find

ings

, an

d m

akes

app

ropr

iate

refe

rral

.

d. E

duca

tes

unre

gist

ered

nur

sing

team

on

the

sign

ifica

nce

and

impo

rtan

ce o

f tak

ing

regu

lar

clin

ical

obs

erva

tions

.

• th

e lo

cal o

utre

ach

team

• th

e im

port

ance

of i

nter

pret

ing

vita

l sig

ns in

re

lati

on to

live

r dis

ease

and

follo

win

g in

vasi

ve

proc

edur

es

• si

gns

and

sym

ptom

s of

det

erio

rati

on, a

nd e

arly

w

arni

ng to

ols

for c

ompl

icat

ions

, inc

ludi

ng:

– sid

e ef

fect

s of

dru

g tr

eatm

ents

– hyp

oten

sion

due

to d

rug

rela

ted

e.g.

pr

opra

nolo

l, an

d no

n-dr

ug re

late

d re

ason

s e.

g.

deco

mpe

nsat

ed li

ver d

isea

se

– jau

ndic

e as

an

indi

cato

r of d

eter

iora

ting

live

r di

seas

e i.e

. ris

e in

bili

rubi

n

– bili

ary

com

plic

atio

ns, i

.e. c

hole

cyst

itis

and

/or

chol

angi

tis

or b

iliar

y ob

stru

ctio

n

– por

tal h

yper

tens

ion

and

oeso

phag

eal v

aric

es

– asc

ites

– hep

ator

enal

failu

re

– acu

te k

idne

y in

jury

– hep

atic

enc

epha

lopa

thy

– sep

sis

whi

ch o

ften

pre

cipi

tate

s va

rice

al b

leed

ing

or h

epat

ic e

ncep

halo

path

y

– car

diov

ascu

lar a

nd re

spir

ator

y co

mpl

icat

ions

– coa

gulo

path

y

– acu

te li

ver f

ailu

re in

clud

ing

risk

of c

ereb

ral

oede

ma.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• W

orks

in p

artn

ersh

ip.

• Su

ppor

tive

.

• En

cour

agin

g.

• Pr

ovid

es c

hoic

es.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• N

on-ju

dgm

enta

l.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

Use

s ea

rly

war

ning

tool

s/ap

proa

ches

(su

ch a

s re

d al

ert)

to id

enti

fy th

e pa

tien

t’s

chan

ging

and

det

erio

rati

ng c

ondi

tion

and

take

s ap

prop

riat

e ac

tion

8

56


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

5•

Pote

ntia

l com

plic

atio

ns p

ost l

iver

tran

spla

nt e

.g.

blee

ding

via

dra

ins,

type

s of

sho

ck, s

epsi

s, b

iliar

y le

aks

and

reje

ctio

n

• un

reco

gnis

ed a

lcoh

ol w

ithd

raw

al.

Kno

w h

ow to

: •

cont

act a

nd re

fer t

o th

e lo

cal o

utre

ach

team

.

• N

HS

Atl

as o

f Var

iati

on:L

iver

(201

3)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is

care

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h.

(con

tinu

ed)

6U

ses

earl

y w

arni

ng to

ols/

ap

proa

ches

(s

uch

as

red

aler

t) to

id

entif

y th

e pa

tient

’s

chan

ging

and

de

teri

orat

ing

cond

ition

, an

d ta

kes

appr

opri

ate

actio

n.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. In

vest

igat

es th

e ca

use

of e

arly

sig

ns o

f de

terio

ratio

n an

d ta

kes

appr

opria

te a

ctio

n.

b. D

ocum

ents

all

findi

ngs

and

liais

es w

ith th

e m

edic

al te

ams.

c. R

ole

mod

els

and

emph

asis

e to

oth

ers

the

impo

rtan

ce o

f bei

ng a

lert

to c

hang

es in

vita

l si

gns.

• re

late

d pa

thop

hysi

olog

ical

cha

nges

that

can

oc

cur s

udde

nly

or g

radu

ally

, res

ulti

ng in

rapi

d de

teri

orat

ion

or d

eath

• di

ffer

ent e

arly

war

ning

tool

s an

d th

eir u

se a

nd

cont

radi

ctio

ns in

pat

ient

s w

ith

liver

dis

ease

e.g

. po

or re

liabi

lity

of G

lasg

ow C

oma

Scal

e in

pat

ient

s w

ith

acut

e liv

er fa

ilure

• di

fficu

lty

of u

sing

som

e to

ols

wit

h pa

tien

ts w

ith

chro

nic

liver

dis

ease

bec

ause

of h

ypot

ensi

on a

nd

poor

rena

l fun

ctio

n et

c.

Kno

ws

how

to:

• or

der a

nd u

nder

take

app

ropr

iate

inve

stig

atio

ns

and

inte

rpre

t res

ults

; ide

ntify

acu

te c

ompl

icat

ions

an

d m

ake

appr

opri

ate

plan

of c

are

and

refe

rral

to

spec

ialis

t tea

m

• un

dert

ake,

reco

rd a

nd a

ct o

n nu

rsin

g ob

serv

atio

ns.

• Em

pow

erin

g.

• V

alue

s le

arni

ng.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• W

orks

in p

artn

ersh

ip.

• Em

brac

es d

iffer

ent p

ersp

ecti

ves.

• A

naly

tica

l.

• A

tten

tion

to d

etai

l.

• M

odel

s be

st p

ract

ice.

Use

s ea

rly

war

ning

tool

s/ap

proa

ches

(su

ch a

s re

d al

ert)

to id

enti

fy th

e pa

tien

t’s

chan

ging

and

det

erio

rati

ng c

ondi

tion

and

take

s ap

prop

riat

e ac

tion

(con

tinu

ed)

8

57


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7U

ses

earl

y w

arni

ng to

ols/

ap

proa

ches

(s

uch

as

red

aler

t) to

id

entif

y th

e pa

tient

’s

chan

ging

and

de

teri

orat

ing

cond

ition

, an

d ta

kes

appr

opri

ate

actio

n.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

G1

a. U

nder

take

s a

full

com

preh

ensi

ve a

sses

smen

t an

d hi

stor

y an

d in

itiat

es tr

eatm

ent a

ccor

ding

to

loca

l gui

danc

e or

pro

toco

l.

b. D

ocum

ents

in th

e nu

rsin

g an

d m

edic

al n

otes

, an

d re

port

s to

spe

cial

ist t

eam

or m

edic

s.

c. E

duca

tes

othe

r nur

ses

and

med

ical

team

s on

the

sudd

en o

r gra

dual

cha

nges

in p

atie

nt

cond

ition

.

d. E

duca

tes

othe

r hea

lth c

are

prof

essi

onal

s on

th

e m

ajor

com

plic

atio

ns o

f liv

er d

isea

se a

nd

sign

s an

d sy

mpt

oms.

• th

e pa

thop

hysi

olog

y an

d th

e co

ntex

t of s

udde

n on

set o

f det

erio

ratio

n pr

ecip

itate

d by

the

dise

ase

proc

ess

and

othe

r pre

cipi

tatin

g fa

ctor

s.

Kno

ws

how

to:

• as

sess

and

iden

tify

sign

ifica

nt s

igns

and

sym

ptom

s,

incl

udin

g th

e fo

llow

ing:

– sid

e ef

fect

s of

dru

g tr

eatm

ents

– hyp

oten

sion

due

to d

rug

rela

ted

e.g.

pr

opra

nolo

l, an

d no

n-dr

ug re

late

d re

ason

s e.

g.

deco

mpe

nsat

ed li

ver d

isea

se

– jau

ndic

e as

an

indi

cato

r of d

eter

iora

ting

liver

di

seas

e i.e

. ris

e in

bili

rubi

n

– bili

ary

com

plic

atio

ns, i

.e.c

hole

cyst

itis

and/

or

chol

angi

tis o

r bili

ary

obst

ruct

ion

– por

tal h

yper

tens

ion

and

oeso

phag

eal v

aric

es

– hep

ato-

rena

l fai

lure

– acu

te k

idne

y in

jury

– hep

atic

enc

epha

lopa

thy

– sep

sis

whi

ch o

ften

pre

cipi

tate

s va

ricea

l ble

edin

g or

hep

atic

enc

epha

lopa

thy

– car

diov

ascu

lar a

nd re

spira

tory

com

plic

atio

ns

– coa

gulo

path

y

– acu

te li

ver f

ailu

re in

clud

ing

risk

of c

ereb

ral

oede

ma

– unr

ecog

nise

d al

coho

l wit

hdra

wal

.

• w

ork

with

in th

e lo

cal g

uide

lines

or p

roto

col,

and

the

scop

e of

pra

ctic

e w

hen

initi

atin

g tr

eatm

ent

• R

ole

mod

el.

• In

ter-

prof

essi

onal

wor

king

.

• Co

llabo

rati

ve.

• In

clus

ive.

• St

rong

clin

ical

lead

ersh

ip.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

es.

• Ch

alle

nges

ass

umpt

ions

and

ta

ken

for g

rant

ed w

ays

of w

orki

ng.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pat

ient

s.

Spec

ific

• N

atio

nal E

arly

War

ning

Sco

re.

• Lo

cal g

uide

lines

and

pro

toco

ls.

• Th

e R

esus

cita

tion

Cou

ncil.

• N

PSA

(200

7) S

afer

car

e fo

r the

ac

utel

y ill

pat

ient

: lea

rnin

g fr

om

seri

ous

inci

dent

s.

• St

anda

rds

for c

linic

al p

ract

ice

and

trai

ning

( jo

int s

tate

men

ts) f

rom

:

– Roy

al C

olle

ge o

f Ana

esth

etis

ts

– Roy

al C

olle

ge o

f Phy

sici

ans

• Th

e In

tens

ive

Care

Soc

iety

.

• R

CN (2

012)

Adv

ance

d N

urse

pr

acti

tion

er a

nd R

CN G

uide

to

adva

nced

nur

sing

pra

ctic

e, a

dvan

ced

nurs

e pr

acti

tion

er a

nd p

rogr

amm

e ac

cred

itat

ion.

Use

s ea

rly

war

ning

tool

s/ap

proa

ches

(su

ch a

s re

d al

ert)

to id

enti

fy th

e pa

tien

t’s

chan

ging

and

det

erio

rati

ng c

ondi

tion

and

take

s ap

prop

riat

e ac

tion

(con

tinu

ed)

8

58


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d

unde

rsta

ndin

g of

:A

ttit

udes

and

beh

avio

urs

Cont

extu

al fa

ctor

s

8U

ses

earl

y w

arni

ng to

ols/

ap

proa

ches

(s

uch

as

red

aler

t) to

id

entif

y th

e pa

tient

’s

chan

ging

and

de

teri

orat

ing

cond

ition

, an

d ta

kes

appr

opri

ate

actio

n.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

G1

a. C

ontr

ibut

es to

org

anis

atio

n’s

stra

tegy

and

po

licie

s fo

r man

agin

g de

terio

ratin

g pa

tient

s.

b. P

rovi

des

expe

rt re

view

of p

atie

nts

who

hav

e de

terio

rate

d du

e to

live

r con

ditio

ns a

cros

s ow

n or

gani

satio

n an

d ot

her o

rgan

isat

ions

.

c. C

olla

bora

tes

in re

sear

ch p

rogr

amm

es th

at

addr

ess

dete

riora

ting

patie

nts

with

live

r co

nditi

ons

and

thei

r man

agem

ent.

• th

e de

teri

orat

ing

liver

pat

ient

and

opt

imis

ing

trea

tmen

t opt

ions

to p

reve

nt fu

rthe

r de

teri

orat

ion

• re

ferr

al to

oth

er h

ealt

h ca

re p

rofe

ssio

nals

or f

rom

ot

her o

rgan

isat

ions

• st

rate

gic

aim

s in

rela

tion

to li

ver p

atie

nts

and

outr

each

ser

vice

• cl

inic

al tr

ials

and

recr

uitm

ent t

o tr

ials

whe

re

appr

opri

ate.

Kno

ws

how

to:

• re

cogn

ise

in a

tim

ely

man

ner t

he a

cute

live

r fa

ilure

pat

ient

• re

cogn

ise

the

pati

ent w

ith

on-g

oing

var

icea

l bl

eedi

ng a

nd c

onsi

der s

uita

ble

trea

tmen

t opt

ions

w

ith

colle

ague

s

• su

ppor

t sta

ff to

iden

tify

the

dete

rior

atin

g liv

er

pati

ent.

• St

rong

asp

irat

iona

l lea

ders

hip.

• Co

llabo

rati

ve w

orki

ng a

cros

s se

rvic

es.

• Pa

ssio

nate

abo

ut p

atie

nt s

afet

y.

See

abov

e.

Use

s ea

rly

war

ning

tool

s/ap

proa

ches

(su

ch a

s re

d al

ert)

to id

enti

fy th

e pa

tien

t’s

chan

ging

and

det

erio

rati

ng c

ondi

tion

and

take

s ap

prop

riat

e ac

tion

(con

tinu

ed)

8

59


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7Ac

tivel

y im

prov

es a

nd

prom

otes

se

rvic

es a

cros

s th

e ca

re

path

way

.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

Core

4

Core

5

G1

a. P

rovi

des

clin

ical

lead

ersh

ip fo

r nur

ses

and

heal

th c

are

prof

essi

onal

s in

volv

ed w

ith c

are

of

thos

e w

ith a

cute

and

chr

onic

live

r dis

ease

.

b. W

rites

and

upd

ates

pro

toco

ls fo

r car

e pa

thw

ays.

c. E

nsur

es s

moo

th tr

ansf

er a

nd d

ocum

enta

tion

of

patie

nts

ente

ring

into

and

leav

ing

loca

l ser

vice

s.

d. U

nder

take

s re

gula

r ser

vice

revi

ews/

audi

ts a

nd

take

s ap

prop

riate

act

ion

to im

prov

e se

rvic

e.

e. O

rgan

ises

feed

back

from

pat

ient

s, th

eir

fam

ilies

/car

ers

and

mak

es a

ppro

pria

te c

hang

es

to e

nsur

e se

rvic

es m

eet p

atie

nts’

nee

ds.

f. Co

mm

unic

ates

eff

ectiv

ely

and

in a

tim

ely

way

w

ith o

ther

hea

lth c

are

prac

titio

ners

to e

nabl

e co

nsis

tent

sta

ndar

ds o

f car

e to

be

impl

emen

ted.

g. P

rovi

des

staf

f tra

inin

g an

d as

sess

men

t fo

r nur

ses

wor

king

with

pat

ient

s w

ith li

ver

dise

ase,

e.g

. tra

inin

g of

A &

E s

taff

to re

cogn

ise

sym

ptom

s.

h. K

eeps

up

to d

ate

with

med

ical

/nur

sing

re

sear

ch s

o th

at n

ew d

evel

opm

ents

are

ado

pted

.

i. En

sure

s th

at c

are

path

way

s ar

e se

amle

ss fo

r pa

tient

s by

eng

agin

g w

ith o

wn

inst

itutio

n (e

.g.

A&E)

and

oth

er s

ervi

ce p

rovi

ders

, inc

ludi

ng:

– ou

tpat

ient

s

– ot

her s

peci

alis

t ser

vice

s (e

.g. d

rug

and

alco

hol,

card

iac,

psy

chol

ogic

al)

– pr

imar

y ca

re (i

nclu

ding

com

mun

ity a

nd

prac

tice

nurs

es)

– ot

her h

ospi

tals

– ed

ucat

ion,

incl

udin

g sc

hool

nur

ses

and

univ

ersi

ty s

taff

– so

cial

ser

vice

s, h

ousi

ng a

nd b

enefi

ts a

dvis

ers

– vo

lunt

ary

sect

or a

nd lo

cal s

uppo

rt n

etw

orks

.

j. W

orks

in c

onju

nctio

n w

ith li

ver c

harit

ies

and

supp

ort g

roup

s.

k. W

orks

with

oth

er h

ealth

car

e pr

ofes

sion

als

to

run

nurs

e-le

d cl

inic

s an

d se

rvic

es.

(con

tinu

ed)

• re

leva

nt N

ICE

guid

elin

es

• he

alth

and

wel

l bei

ng s

trat

egie

s fo

r hea

lthy

live

rs

and

lifes

tyle

s

• cl

inic

al g

over

nanc

e

• ap

prai

sal a

nd s

taff

dev

elop

men

t (KS

F)

• as

sess

ing

com

pete

nce

• cl

inic

al s

uper

visi

on a

nd m

ento

ring

• et

hics

• ba

rrie

rs to

con

tinu

ity

and

the

stra

tegi

es to

ov

erco

me

thes

e ba

rrie

rs

• re

sour

ce im

plic

atio

ns in

rela

tion

to fu

ndin

g of

th

erap

ies

• PR

OM

s an

d PR

EMs.

Kno

ws

how

to:

• su

bmit

pro

toco

ls fo

r app

rova

l acc

ordi

ng to

loca

l gu

idan

ce

• co

nduc

t res

earc

h ac

cord

ing

to lo

cal e

thic

s an

d go

vern

ance

gui

danc

e

• un

dert

ake

audi

t and

und

erta

ke q

ualit

y re

view

s

• en

able

all

grad

es o

f sta

ff w

ith

thei

r lea

rnin

g an

d de

velo

pmen

t aro

und

prom

otin

g he

alth

y liv

ers

and

lifes

tyle

s.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• Su

ppor

tive

.

• En

cour

agin

g.

• Em

pow

erin

g.

• Pr

ovid

es c

hoic

es.

• G

ives

and

rece

ives

feed

back

.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• N

on-ju

dgm

enta

l.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

• Pa

tien

t cen

tred

and

co

mpa

ssio

nate

.

• Li

sten

s.

• U

nder

stan

ding

.

• W

elco

min

g.

• O

pen

to re

ceiv

ing

feed

back

.

• R

espe

cts

confi

dent

ialit

y.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• R

ole

mod

els

heal

thy

livin

g.

• In

terp

rofe

ssio

nal w

orki

ng.

• Em

brac

es d

iffer

ent p

ersp

ecti

ves.

• A

tten

tion

to d

etai

l.

• M

odel

s be

st p

ract

ice.

Gen

eric

•

NM

C do

cum

ents

and

gui

danc

e.

• R

oyal

Col

lege

of N

ursi

ng d

ocum

ents

an

d gu

idan

ce.

• R

CN G

astr

oint

estin

al N

ursi

ng F

orum

.

• B

ritis

h As

soci

atio

n fo

r the

Stu

dy o

f the

Li

ver N

urse

s Fo

rum

(BAS

LNF)

.

• B

ritis

h Li

ver N

urse

s Fo

rum

(BLN

F).

• N

HS

Engl

and.

• D

H (2

009)

Mak

ing

a D

iffer

ence

.

• P

ublic

Hea

lth E

ngla

nd.

• N

HS

Empl

oyer

s an

d Sk

ills

Fram

ewor

k.

• G

old

Stan

dard

s Fr

amew

ork

for p

eopl

e ne

arin

g th

e en

d of

life

.

• N

HS

(200

9) c

ore

com

pete

nces

for e

nd

of li

fe c

are.

• N

atio

nal E

nd o

f liv

e Ca

re In

telli

genc

e N

etw

ork

(201

2) D

eath

s fro

m L

iver

D

isea

se. I

mpl

icat

ions

for e

nd o

f lif

e ca

re.

• N

ICE

liver

gui

danc

e.

• M

enta

l Cap

acity

Act

200

5.

• N

HS

Com

mis

sion

Boa

rd S

afeg

uard

ing

vuln

erab

le p

eopl

e in

the

refo

rmed

NH

S .

• D

H C

onse

nt 2

009.

• D

ata

Prot

ectio

n Ac

t 199

8.

• N

HS

Choi

ces.

• N

HS

Inst

itute

for I

nnov

atio

n an

d Im

prov

emen

t.

• Q

ualit

y O

utco

me

Mea

sure

s, s

uch

as,

CQU

INS,

PRO

MS

etc.

• Th

e La

ncet

Com

mis

sion

(Will

iam

s et

al,

2014

)

• N

ECPO

D 2

013

Mea

surin

g th

e un

its:

a re

view

of p

atie

nts

who

die

d w

ith

alco

hol-r

elat

ed li

ver d

isea

se,

Lond

on, N

CEPO

D.

• N

HS

IQ (I

mpr

ovin

g qu

ality

)

• N

ursi

ng T

imes

Lea

rnin

g U

nit.

Live

r D

isea

se: R

isk

fact

ors

and

trea

tmen

t (fr

ee a

cces

s)

Act

ivel

y im

prov

es a

nd p

rom

otes

live

r se

rvic

es a

cros

s th

e ap

prop

riat

e ca

re p

athw

ay9

60


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

7Se

e ab

ove

See

abov

el.

Co-o

rdin

ates

tran

sitio

n so

that

you

ng p

eopl

e ca

n m

ove

confi

dent

ly a

nd s

eam

less

ly fr

om

paed

iatr

ic to

adu

lt se

rvic

es.

m. D

evel

ops

and

eval

uate

s ou

trea

ch s

ervi

ces.

n. L

eads

, man

ages

and

app

rais

es s

taff

acr

oss

the

serv

ice.

o. D

evel

ops

loca

l and

regi

onal

net

wor

ks to

su

ppor

t exc

elle

nce

in n

ursi

ng fo

r peo

ple

with

liv

er d

isea

se.

p. P

rom

otes

, rol

e m

odel

s an

d co

ache

s ot

hers

in

heal

th a

nd w

ell b

eing

aro

und

min

imis

ing

liver

di

seas

e.

q. U

nder

take

s te

achi

ng in

rele

vant

pos

t-re

gist

ratio

n co

urse

s.

See

abov

eSe

e ab

ove

Gen

eric

•

NH

S A

tlas

of V

aria

tion

:Liv

er (2

013)

• N

atio

nal C

linic

al G

uide

lines

Cen

tre.

• B

ASL

/B

SG: D

ecom

pens

ated

Cir

rhos

is

care

Bun

dle:

Fir

st 2

4 ho

urs

• N

HS

Engl

and

(201

3) T

he 6

Cs

• Ke

y qu

alit

y as

sure

d pa

tien

t and

car

er

info

rmat

ion

and

supp

ort f

rom

key

ch

arit

ies

and

orga

nisa

tion

s, s

uch

as:

– B

riti

sh L

iver

Tru

st–

Child

ren’

s Li

ver D

isea

se F

ound

atio

n–

Alc

ohol

Con

cern

– Th

e H

epat

itis

C T

rust

– H

epat

itis

B F

ound

atio

n U

K–

Hae

moc

hrom

atos

is S

ocie

ty–

Wils

on’s

Dis

ease

Sup

port

G

roup

(UK)

– PB

C Fo

unda

tion

– R

are

Dis

ease

s U

K–

PSC

Supp

ort

– R

oyal

col

lege

s, s

uch

as, P

hysi

cian

s,

Gen

eral

Pra

ctit

ione

rs, S

urge

ons,

A

naes

thet

ists

– B

riti

sh S

ocie

ty o

f Gas

troe

nter

olog

y (B

SG)

– B

riti

sh A

ssoc

iati

on fo

r the

Stu

dy o

f th

e Li

ver (

BA

SL)

– Eu

rope

an A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)–

Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D)

– B

riti

sh A

ssoc

iati

on o

f Par

ente

ral

and

Ente

ral N

utri

tion

(BA

PEN

)

• N

HS

Engl

and

The

In

form

atio

n St

anda

rd

• B

riti

sh N

atio

nal F

orm

ular

y (B

NF)

• Sk

ills

for H

ealt

h

Spec

ific

• R

CN (2

010)

Mea

suri

ng th

e qu

alit

y of

H

ealt

h Ca

re: a

pos

itio

n st

atem

ent.

• R

CN (2

014)

The

eig

ht p

rinc

iple

s.

• D

H E

lect

roni

c in

form

atio

n sy

stem

s.

8Ac

tivel

y pr

omot

es

and

impr

oves

se

rvic

es a

cros

s th

e ca

re

path

way

Core

1

HW

B1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

Core

4

Core

5

G1

G2

G6

G7

Ik3

a. C

ontr

ibut

es to

qua

lity

acco

unts

, CQ

UIN

and

Q

IPP

activ

ity a

nd d

irect

ion.

b. E

ngag

es w

ith o

ther

par

ts o

f the

org

anis

atio

n co

ncer

ning

the

who

le c

are

path

way

so

that

car

e is

sea

mle

ss fo

r pat

ient

s.

c. E

nsur

es s

moo

th a

nd s

afe

wor

king

acr

oss

the

serv

ice

and

orga

nisa

tion.

d. A

dvoc

ates

for p

atie

nts

and

influ

ence

s co

mm

issi

onin

g.

e. E

nsur

es re

leva

nt c

linic

al d

ata

are

confi

dent

ially

col

lect

ed, a

udite

d an

d ev

alua

ted

to s

uppo

rt a

nd im

prov

e pa

tient

car

e ac

ross

or

gani

satio

nal b

ound

arie

s.

f. D

eliv

ers

wor

ksho

ps/c

onfe

renc

es.

g. Im

plem

ents

nur

se-le

d cl

inic

s an

d se

rvic

es

that

add

ress

the

heal

th n

eeds

of p

atie

nts

with

liv

er d

isea

se.

h. C

ontin

uous

ly id

entifi

es g

aps

in s

ervi

ce,

deve

lops

inno

vativ

e so

lutio

ns a

nd m

onito

rs

outc

omes

.

i. Le

ads,

man

ages

and

app

rais

es s

taff

acr

oss

the

orga

nisa

tion,

dev

elop

ing

the

lead

ersh

ip

pote

ntia

l of a

ll.

(con

tinu

ed)

• w

orki

ng a

t a s

trat

egic

leve

l wit

hin

own

orga

nisa

tion

• lo

cal n

etw

orks

• pr

imar

y ca

re s

ervi

ces

• th

e se

rvic

es o

ffer

ed b

y th

e vo

lunt

ary

sect

or

• th

e se

rvic

es o

ffer

ed b

y th

e st

atut

ory

sect

or

(inc

ludi

ng lo

cal s

choo

ls, l

ocal

hou

sing

de

part

men

ts a

nd lo

cal s

ocia

l ser

vice

s de

part

men

ts)

• st

anda

rds

and

polic

ies

• qu

alit

y ac

coun

ts, C

omm

issi

onin

g fo

r Qua

lity

and

Inno

vati

on (C

QU

IN) a

nd Q

ualit

y, In

nova

tion

, Pr

even

tion

and

Pro

duct

ivit

y Q

IPP

• de

velo

pmen

ts a

nd in

nova

tion

s

• th

e co

nseq

uenc

es o

f poo

r pra

ctic

e

• be

st in

dica

tors

• le

ader

ship

‘cha

mpi

on’ s

kills

• ch

ange

/dev

elop

men

t ski

lls

• th

e sk

ills

need

ed to

bui

ld g

ood

rela

tion

ship

s w

ith

prof

essi

onal

col

leag

ues

in o

ther

dep

artm

ents

and

se

rvic

es

• th

e pr

eval

ence

rate

of l

iver

dis

ease

s in

loca

l po

pula

tion

s.

(con

tinu

ed)

• St

rong

clin

ical

lead

ersh

ip.

• Co

llabo

rati

ve w

orki

ng a

cros

s se

rvic

es.

• Ch

ampi

ons

pers

on c

entr

ed

appr

oach

.

• In

clus

ive.

• Ch

alle

nges

ass

umpt

ions

and

ta

ken

for g

rant

ed w

ays

of

wor

king

.

• A

naly

tica

l.

• Ch

ampi

ons

pati

ent s

afet

y.

Act

ivel

y im

prov

es a

nd p

rom

otes

live

r se

rvic

es a

cros

s th

e ap

prop

riat

e ca

re p

athw

ay (c

onti

nued

)

9

61


Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Co

ntex

tual

fact

ors

8Se

e ab

ove.

See

abov

e.j.

Neg

otia

tes

and

influ

ence

s ke

y st

akeh

olde

rs

tow

ards

exc

elle

nce

in n

ursi

ng o

f pat

ient

s w

ith

liver

dis

ease

.

k. E

nsur

es g

ood

clin

ical

gov

erna

nce

and

acco

unta

bilit

y ac

ross

the

serv

ice

and

orga

nisa

tion.

l. U

nder

take

s re

sear

ch a

nd p

ublis

hes.

• in

form

atio

n sy

stem

s fo

r sha

ring

info

rmat

ion

acro

ss b

ound

arie

s

• ev

alua

tion

, pro

fess

iona

l sta

ndar

ds a

nd

mea

sure

men

t and

the

rela

tion

ship

bet

wee

n th

em

• di

ffer

ent r

esea

rch

appr

oach

es to

dev

elop

ing

know

ledg

e of

saf

e, e

ffec

tive

and

per

son-

cent

red

care

.

Kno

ws

how

to:

• ut

ilise

pat

ient

info

rmat

ion

syst

ems

• m

aint

ain

pati

ent r

ecor

ds in

com

plia

nce

wit

h st

anda

rds

at lo

cal l

evel

and

acr

oss

the

NH

S qu

alit

y im

prov

emen

t and

pra

ctic

e de

velo

pmen

t st

rate

gies

• sh

are

good

pra

ctic

e

• ev

alua

te c

are,

ass

ess

effe

ctiv

enes

s an

d us

e au

dit

tool

s

• ta

ke fo

rwar

d Q

IPP

in e

very

day

prac

tice

• de

velo

p a

cult

ure

of e

ffec

tive

ness

in th

e w

orkp

lace

.

See

abov

e.Se

e ab

ove.

Act

ivel

y im

prov

es a

nd p

rom

otes

live

r se

rvic

es a

cros

s th

e ap

prop

riat

e ca

re p

athw

ay (c

onti

nued

)

9

62


Appendix 1:nurse census of roles

(Department of Health, 2012) This information was collected as a quick “snap shot” of liver nursing roles and is not

a complete reflection of the full liver nurse workforce.

63


Sen

ior

staf

f nur

se/j

unio

r si

ster

rol

eCo

mpe

tenc

e N

umbe

r 1

– P

rovi

des

empa

thy

and

unde

rsta

ndin

g an

d w

orks

wit

h th

e pa

tien

t (an

d th

eir

fam

ily/

care

rs) a

nd p

arti

cula

rly

thos

e w

ith

chro

nic

live

r di

seas

e as

exp

erts

in th

eir

own

cond

itio

n

App

endi

x 2:

Exa

mpl

es o

f evi

denc

e to

mee

t Car

ing

for p

eopl

e w

ith

liver

di

seas

e: a

com

pete

nce

fram

ewor

k fo

r nur

sing

*

* Th

ese

are

inte

nded

onl

y as

a g

uide

in o

rder

to a

chie

ve a

n in

divi

dual

com

pete

nce.

The

re m

ay b

e ot

her e

xam

ples

of l

iver

nur

sing

car

e th

at c

ould

be

used

as

evid

ence

to a

chie

ve th

e co

mpe

tenc

e.

Exam

ples

of

evid

ence

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Ev

iden

ce t

o ac

hiev

e co

mpe

tenc

e

6Pr

ovid

es

empa

thy

and

unde

rsta

ndin

g an

d w

orks

w

ith th

e pa

tient

(and

th

eir f

amily

/ ca

rers

) and

pa

rtic

ular

ly

thos

e w

ith

chro

nic

liver

di

seas

e as

ex

pert

s in

thei

r ow

n co

nditi

on.

Core

1

Core

6

HW

B1

HW

B3

HW

B4

HW

B5

HW

B6

a. S

uppo

rts

team

mem

bers

to c

o-de

velo

p,

impl

emen

t and

eva

luat

e pe

rson

al c

are

plan

s.

b. A

cts

as a

role

mod

els

to e

nsur

e th

at te

am

mem

bers

ena

ble

the

pati

ent’

s vo

ice

to b

e he

ard

and

acte

d on

.

• ad

voca

cy n

eeds

for t

hose

who

are

less

abl

e to

ac

t for

them

selv

es d

ue to

thei

r liv

er c

ondi

tion

le

adin

g to

cha

lleng

ing

beha

viou

r, d

epre

ssio

n or

in

abili

ty to

art

icul

ate

thei

r nee

ds d

ue to

hep

atic

en

ceph

alop

athy

or o

ther

cog

niti

ve im

pair

men

t

• ac

ute

and

long

-ter

m c

ompl

icat

ions

rela

ted

to li

ver

dise

ase

• st

rate

gies

pat

ient

s ca

n us

e fo

r man

agin

g co

-mor

bidi

ties

• of

loca

l and

nat

iona

l str

ateg

y fo

r pat

ient

s w

ith

liver

dis

ease

and

how

to c

ontr

ibut

e

• Pa

tien

t Rep

orte

d O

utco

me

Mea

sure

s (P

RO

MS)

an

d Pa

tien

t Rep

orte

d Ex

peri

ence

Mea

sure

s (P

REM

S).

Kno

ws

how

to:

• bu

ild a

nd fo

ster

an

equi

tabl

e nu

rse-

pati

ent

rela

tion

ship

• w

ork

wit

h pa

tien

ts w

ith

chal

leng

ing

beha

viou

r an

d co

llabo

rati

vely

dev

elop

car

e pl

ans

• di

ffus

e an

ger a

nd c

halle

ngin

g be

havi

our

• de

velo

p ca

re p

lans

in c

onju

ncti

on w

ith

loca

l gu

idel

ines

.

• M

odel

s be

st p

ract

ice.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pat

ient

s.

• Ch

alle

nges

oth

ers.

• Pl

ans,

impl

emen

ts a

nd e

valu

ates

an

agre

ed c

are

plan

wit

h th

e pa

tien

t and

/o

r the

ir c

arer

s.

• Ca

n de

mon

stra

te u

nder

stan

ding

of

pati

ent’

s ca

re n

eeds

and

adv

ocat

es

for t

he p

atie

nt o

n th

e w

ard

roun

d or

at

rele

vant

MD

T m

eeti

ngs.

• G

ives

app

ropr

iate

info

rmat

ion

to

pati

ents

or t

heir

car

ers

and

sign

pos

ts

them

to o

ther

sou

rces

of i

nfor

mat

ion

such

as

the

Bri

tish

Liv

er T

rust

.

• A

ble

to w

rite

a re

flect

ive

acco

unt

of a

n ep

isod

e of

car

e th

at m

ay b

e ch

alle

ngin

g fo

r the

ir o

wn

pers

onal

an

d pr

ofes

sion

al d

evel

opm

ent.

• Is

abl

e to

sup

port

juni

or n

urse

s in

as

sess

ing

and

impl

emen

ting

a c

are

plan

that

focu

ses

on a

n as

pect

of

care

suc

h as

hep

atic

enc

epha

lopa

thy,

co

ntin

ued

alco

hol d

epen

denc

e an

d /

or d

epre

ssio

n.

• Is

abl

e to

und

erta

ke o

r con

trib

ute

to re

leva

nt li

ver n

ursi

ng a

udit

s,

diss

emin

ate

outc

omes

and

cha

nge

prac

tice

whe

re re

leva

nt.

• Id

enti

fy o

wn

lear

ning

nee

ds to

su

ppor

t the

se p

atie

nts

such

as

a fo

rmal

live

r edu

cati

on a

t a h

ighe

r ed

ucat

ion

inst

itut

e; lo

cal a

nd n

atio

nal

liver

rela

ted

stud

y da

ys o

r loc

al c

ours

e su

ch a

s co

nflic

t res

olut

ion

or s

peci

fic

man

agem

ent a

nd le

ader

ship

cou

rses

.

64


Exam

ples

of

evid

ence

Pra

ctic

e nu

rse

role

Com

pete

nce

Num

ber

2 –

Sig

npos

ts a

nd s

uppo

rts

pati

ents

(an

d fa

mil

ies/

care

rs) i

n th

eir

unde

rsta

ndin

g of

thei

r co

ndit

ion

thro

ugh

pati

ent e

duca

tion

and

hea

lth

prom

otio

n

* Th

ese

are

inte

nded

onl

y as

a g

uide

in o

rder

to a

chie

ve a

n in

divi

dual

com

pete

nce.

The

re m

ay b

e ot

her e

xam

ples

of l

iver

nur

sing

car

e th

at c

ould

be

used

as

evid

ence

to a

chie

ve th

e co

mpe

tenc

e.

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Ev

iden

ce t

o ac

hiev

e co

mpe

tenc

e

5Si

gnpo

sts

and

supp

orts

pa

tient

s (a

nd

fam

ilies

/ ca

rers

) in

thei

r un

ders

tand

ing

of th

eir

cond

ition

th

roug

h pa

tient

ed

ucat

ion

and

heal

th

prom

otio

n.

HW

B1

HW

B2

HW

B3

HW

B5

HW

B6

Core

1

Core

3

a. A

sses

ses

know

ledg

e an

d un

ders

tand

ing

of

pati

ent’

s an

d ca

rer’

s ow

n co

ndit

ion,

cau

ses,

risk

fa

ctor

s an

d co

nseq

uenc

es.

b. P

rovi

des

tailo

red

educ

atio

n to

pat

ient

and

fa

mily

/car

ers

on c

ondi

tion

, tre

atm

ents

and

si

de-e

ffec

ts.

c. P

rovi

des

info

rmat

ion

abou

t life

styl

e fa

ctor

s,

cons

eque

nces

and

ser

vice

s av

aila

ble

to s

uppo

rt

lifes

tyle

cha

nges

.

d. R

efer

s to

oth

er a

ppro

pria

te h

ealt

h ca

re

prof

essi

onal

s if

requ

ired

.

• ri

sk fa

ctor

s e.

g. d

rugs

, obe

sity

, alc

ohol

• in

form

atio

n e.

g. D

H D

rink

wis

e, e

duca

tion

and

su

ppor

t res

ourc

es, s

ervi

ces

and

spec

ialis

t sta

ff

avai

labl

e

• di

ffer

ent c

omm

unic

atio

n an

d en

gage

men

t ap

proa

ches

to p

rovi

ding

edu

cati

on a

nd

info

rmat

ion

• he

alth

pro

mot

ion,

sex

ual h

ealt

h st

rate

gies

and

e-

lear

ning

reso

urce

s av

aila

ble

e.g.

from

PH

E A

lcoh

ol L

earn

ing

Res

ourc

es

• po

siti

ve li

fest

yle

appr

oach

es a

nd a

dvic

e

• ho

w to

giv

e br

ief a

dvic

e an

d in

terv

enti

ons.

Kno

ws

how

to:

• ta

ilor i

nfor

mat

ion

and

educ

atio

n to

the

pers

on

• ob

tain

edu

cati

onal

info

rmat

ion

or d

irec

t pat

ient

s/fa

mili

es/c

arer

s to

ava

ilabl

e re

sour

ces,

ser

vice

s an

d st

aff,

incl

udin

g th

e vo

lunt

ary

sect

or

• w

ork

wit

hin

thei

r lev

el o

f com

pete

nce.

• A

war

e of

role

lim

itat

ions

.

• R

ecog

nise

s ow

n le

vel o

f co

mpe

tenc

e, a

ble

to id

enti

fy

lear

ning

nee

ds.

• A

ccou

ntab

le.

• Em

path

etic

.

• En

cour

agin

g.

• Su

ppor

tive

.

• N

on-ju

dgm

enta

l.

• W

orks

in p

artn

ersh

ip w

ith

othe

rs.

• W

illin

g to

refle

ct o

n an

d le

arn

from

ow

n pr

acti

ce.

• Fl

exib

le.

• Pa

ssio

nate

abo

ut p

atie

nt c

are.

• A

tten

ds a

ccre

dite

d lo

cal u

pdat

es o

n liv

er d

isea

se.

• Lo

cal e

duca

tion

thro

ugh

e-le

arni

ng.

• D

evel

ops

wit

h th

e pr

acti

ce le

ad a

sc

reen

ing

and

heal

th e

duca

tion

pr

ogra

mm

e th

at in

corp

orat

es is

sues

ar

ound

live

r hea

lth

such

as

alco

hol,

risk

fact

ors

for v

iral

hep

atit

is, f

amily

hi

stor

y of

live

r dis

ease

, obe

sity

, pr

evio

us b

lood

tran

sfus

ions

, tat

toos

or

pie

rcin

gs, r

ecen

t ove

rsea

s tr

avel

an

d se

xual

hea

lth.

• D

evel

ops

awar

enes

s of

link

s to

oth

er

chro

nic

dise

ase

grou

ps s

uch

as

diab

etes

, met

abol

ic s

yndr

ome,

hea

rt

dise

ase.

• H

as a

tten

ded

rele

vant

cou

rse

or

upda

tes

in s

uch

as, m

otiv

atio

nal

inte

rvie

win

g, b

rief

adv

ice

or

inte

rven

tion

rela

ted

to a

lcoh

ol.

• U

nder

stan

ds a

nd d

evel

ops

a pa

thw

ay

for r

efer

ral o

f pat

ient

s w

ith

poss

ible

liv

er d

isea

se to

rele

vant

ser

vice

suc

h as

dru

gs a

nd a

lcoh

ol o

r loc

al v

iral

he

pati

tis

serv

ices

.

• D

emon

stra

tes

awar

enes

s of

ava

ilabl

e liv

er re

sour

ces

such

as

web

site

s an

d ch

arit

ies.

65


Clin

ical

Nur

se S

peci

alis

t rol

e Co

mpe

tenc

e N

umbe

r 3

– U

nder

take

s a

com

preh

ensi

ve c

lini

cal a

sses

smen

t inc

ludi

ng r

isk

profi

ling

and

foll

ows

up w

ith

appr

opri

ate

acti

on, i

nclu

ding

ref

erra

l to

spec

iali

sts,

for

rele

vant

ac

ute

and

chro

nic

heal

th c

are

cond

itio

ns

Exam

ples

of

evid

ence

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Ev

iden

ce t

o ac

hiev

e co

mpe

tenc

e

7U

nder

take

s a

com

preh

ensi

ve

phys

ical

as

sess

men

t an

d fo

llow

s up

with

ap

prop

riat

e ac

tion,

in

clud

ing

refe

rral

to

med

ical

sp

ecia

lists

fo

r rel

evan

t ch

roni

c an

d ac

ute

heal

th c

are

cond

ition

s.

Core

1

HW

B3

HW

B5

HW

B6

HW

B7

Core

3

a. A

sses

ses,

dia

gnos

es a

nd tr

eats

peo

ple

wit

h on

-goi

ng li

ving

dis

ease

and

its

com

plic

atio

ns.

b. U

nder

take

s a

med

ical

his

tory

, com

plet

es a

de

taile

d ph

ysic

al a

nd n

ursi

ng e

xam

inat

ion,

fo

rmul

ates

a d

iagn

osis

, ini

tiat

es in

vest

igat

ions

an

d/or

trea

tmen

ts a

nd re

fers

to s

peci

alis

t tea

ms

as a

ppro

pria

te.

c. D

iagn

oses

new

or w

orse

ning

com

plic

atio

ns

of a

cute

and

chr

onic

live

r dis

ease

.

d. Id

enti

fies

earl

y si

gns

of o

ther

dis

ease

s.

e. P

rovi

des

the

pati

ent w

ith

info

rmat

ion

on h

ow

to m

anag

e an

d m

onit

or s

peci

fic s

ympt

oms.

f. Im

plem

ents

end

of l

ife c

are

for t

he p

atie

nt

and

thei

r fam

ily, p

rovi

des

supp

ort a

nd re

fers

to

the

appr

opri

ate

heal

th p

rofe

ssio

nals

.

• al

l cau

ses

of li

ver d

isea

se in

clud

ing

thos

e re

late

d to

occ

upat

ion

and

trav

el

• co

mpl

icat

ions

of a

cute

and

chr

onic

live

r dis

ease

• de

sign

ing,

impl

emen

ting

and

eva

luat

ing

a m

anag

emen

t pla

n th

at in

clud

es s

peci

fic s

igns

an

d sy

mpt

oms

or s

ide

effe

cts

such

as:

– pru

ritu

s

– ski

n ra

shes

as

side

eff

ects

of d

rug

trea

tmen

ts

espe

cial

ly in

rela

tion

to v

iral

hep

atit

is

– hyp

oten

sion

due

to d

rug

rela

ted

reas

ons

e.g.

Pr

opra

nolo

l, an

d no

n-dr

ug re

late

d re

ason

s e.

g.

deco

mpe

nsat

ed li

ver d

isea

se

– jau

ndic

e

– bili

ary

com

plic

atio

ns, i

.e. c

hole

cyst

itis

and

/or

chol

angi

tis

– por

tal h

yper

tens

ion

and

oeso

phag

eal v

aric

es

– asc

ites

/spo

ntan

eous

bac

teri

al p

erit

onit

is

– hep

ator

enal

failu

re

– hep

atic

enc

epha

lopa

thy

– ris

k of

cer

ebra

l oed

ema

in a

cute

live

r fai

lure

– sep

sis

whi

ch o

ften

pre

cipi

tate

s va

rice

al b

leed

ing

or h

epat

ic e

ncep

halo

path

y

– car

diov

ascu

lar a

nd re

spir

ator

y co

mpl

icat

ions

– coa

gulo

path

y

• tr

eatm

ent r

egim

es, i

nclu

ding

elig

ibili

ty a

nd

suit

abili

ty c

rite

ria

for d

iffer

ent l

iver

dis

ease

s

• op

tion

s fo

llow

ing

failu

re o

f tre

atm

ent e

.g. e

arly

re

ferr

al fo

r liv

er tr

ansp

lant

atio

n as

sess

men

t in

chro

nic

liver

dis

ease

• pa

lliat

ion

of s

ympt

oms

e.g.

che

mo-

embo

lisat

ion

or p

arac

ente

sis

and

plan

ning

for e

nd o

f life

car

e.

• R

ole

mod

el.

• In

ter-

prof

essi

onal

wor

king

.

• Co

llabo

rati

ve.

• In

clus

ive.

• St

rong

clin

ical

lead

ersh

ip.

• Ch

ampi

ons

pers

on-c

entr

ed

appr

oach

es.

• Ch

alle

nges

ass

umpt

ions

and

ac

cept

ed w

ays

of w

orki

ng.

• A

ctiv

ely

prom

otes

bet

ter h

ealt

h fo

r pat

ient

s.

• D

emon

stra

tes

a w

ide

rang

e of

kn

owle

dge

and

expe

rien

ce o

f m

anag

ing

pati

ents

wit

h ac

ute

and

chro

nic

liver

dis

ease

.

• A

dvan

ced

asse

ssm

ent s

kill

cour

se a

t de

gree

or m

aste

rs le

vel.

• Fo

rmal

live

r edu

cati

on a

t deg

ree

or

mas

ters

leve

l.

• In

depe

nden

t pre

scri

bing

cou

rse

at

degr

ee o

r mas

ters

leve

l.

• Pr

esen

ts p

atie

nts

and

care

pla

ns to

m

ulti

dis

cipl

inar

y te

am.

• Ke

eps

up-t

o-da

te w

ith

new

and

ch

angi

ng tr

eatm

ents

thro

ugh

stud

y da

ys s

uch

as:

– RCN

Gas

troi

ntes

tina

l Nur

sing

For

um

– Bri

tish

Ass

ocia

tion

for t

he S

tudy

of

the

Live

r Nur

ses

Foru

m (B

ASL

NF)

– Bri

tish

Liv

er N

urse

s Fo

rum

(BLN

F).

• O

r rel

evan

t med

ical

con

fere

nces

suc

h as

:

– Bri

tish

Soc

iety

of G

astr

oent

erol

ogy

(BSG

)

– Bri

tish

Ass

ocia

tion

for t

he S

tudy

of

the

Live

r (B

ASL

)

– Eur

opea

n A

ssoc

iati

on fo

r the

Stu

dy

of th

e Li

ver (

EASL

)

– Am

eric

an A

ssoc

iati

on fo

r the

Stu

dy

of L

iver

Dis

ease

s (A

ASL

D).

• R

elev

ant a

dvan

ced

clin

ical

pra

ctic

e do

cum

ents

to s

uppo

rt c

linic

al ro

le.

• Pr

esen

ting

wor

k at

con

fere

nces

.

• W

riti

ng lo

cal a

nd n

atio

nal g

uide

lines

.

66


Exam

ples

of

evid

ence

Leve

lCo

mpe

tenc

eK

SF

Per

form

ance

cri

teri

aK

now

ledg

e an

d un

ders

tand

ing

of:

Att

itud

es a

nd b

ehav

iour

s Ev

iden

ce t

o ac

hiev

e co

mpe

tenc

e

7K

now

s ho

w to

:•

unde

rtak

e a

deta

iled

clin

ical

and

nur

sing

as

sess

men

t

• un

dert

ake

an a

bdom

inal

ass

essm

ent a

nd o

ther

sy

stem

s as

app

ropr

iate

• ex

plai

n si

gnifi

canc

e of

any

inve

stig

atio

ns to

pa

tien

ts

• in

itia

te in

vest

igat

ions

app

ropr

iate

ly

• ac

t on

inve

stig

atio

ns a

nd in

terp

ret r

esul

ts

incl

udin

g liv

er s

cree

n

• fo

rmul

ate

an a

ppro

pria

te m

anag

emen

t pla

n in

clud

ing,

whe

re a

ppro

pria

te, e

nd o

f life

car

e

• id

enti

fy a

cute

alc

ohol

wit

hdra

wal

and

saf

ely

prov

ide

phar

mac

olog

ical

man

agem

ent o

f sy

mpt

oms

duri

ng a

n ep

isod

e ac

ute

alco

hol

wit

hdra

wal

• ad

min

iste

r tre

atm

ent w

ithi

n th

eir s

peci

alis

t rol

e as

a

non-

med

ical

pre

scri

ber

• re

cogn

ise,

man

age

and

refe

r pat

ient

s in

rela

tion

to

thei

r co-

mor

bidi

ties

• as

sess

com

pete

nce

of n

urse

s un

dert

akin

g cl

inic

al

asse

ssm

ents

• ac

t as

a ro

le m

odel

.

• Pu

blis

hing

art

icle

s in

nur

sing

and

/or

m

edic

al jo

urna

ls.

• D

emon

stra

ting

lead

ersh

ip a

nd

init

iati

ng c

hang

e.

• Fo

cuse

d on

pat

ient

out

com

es,

wor

king

wit

h th

e pa

tien

t or s

peci

fic

grou

ps e

.g. v

iral

hep

atit

is, a

lcoh

ol

rela

ted

liver

dis

ease

and

NA

FLD

.

Clin

ical

nur

se s

peci

alis

t rol

e (c

onti

nued

)

Com

pete

nce

Num

ber

3 –

Und

erta

kes

a co

mpr

ehen

sive

cli

nica

l ass

essm

ent i

nclu

ding

ris

k pr

ofili

ng a

nd fo

llow

s up

wit

h ap

prop

riat

e ac

tion

, inc

ludi

ng r

efer

ral t

o sp

ecia

list

s, fo

r re

leva

nt a

cute

and

chr

onic

hea

lth

care

con

diti

ons

67


Leve

lCo

mpe

tenc

eEv

iden

ce t

o ac

hiev

e co

mpe

tenc

e

App

endi

x 3:

Bla

nk c

ompe

tenc

e sh

eet t

o pr

oduc

e ow

n ev

iden

ce fo

r Ca

ring

for p

eopl

e w

ith

liver

dis

ease

: a c

ompe

tenc

e fr

amew

ork

for

nurs

ing

Nam

eR

ole

Hos

pita

l

Nur

se s

igna

ture

Asse

ssor

sig

natu

reD

ate

Has

the

com

pete

nce

been

ach

ieve

d? Y

ES

NO

Plea

se m

ake

com

men

ts a

nd if

any

furt

her p

lann

ing

requ

ired

:

68


Bla

nk c

ompe

tenc

e sh

eet t

o pr

oduc

e ow

n ev

iden

ce fo

r Car

ing

for

peop

le w

ith

liver

dis

ease

: a c

ompe

tenc

e fr

amew

ork

for n

ursi

ng

Nur

se s

igna

ture

Asse

ssor

sig

natu

reD

ate

Leve

lCo

mpe

tenc

eEv

iden

ce t

o ac

hiev

e co

mpe

tenc

e

Nam

eR

ole

Hos

pita

l

Has

the

com

pete

nce

been

ach

ieve

d? Y

ES

NO

Plea

se m

ake

com

men

ts a

nd if

any

furt

her p

lann

ing

requ

ired

:

69


Appendix 4: References

Babor T, Higgins-Biddle J, Saunders j, Monteiro M (2011) AUDIT The Alcohol Use Disorders Identification Test Guidelines for use in primary care 2nd edition, WHO

Benner P (1982) From novice to expert. American Journal of Nursing, 82(3), pp.402-407.

Department of Health (2010) National Liver Disease Strategy (unpublished) Nurse census via SHA

Department of Health (2012) Compassion in Practice. Nursing, Midwifery and Care Staff. Our vision and strategy. Department of Health, Leeds.

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2013) Alcohol-related liver disease: measuring the units. Available at: http://www.ncepod.org.uk/2013arld.htm [accessed 29 June 2015]

National End of Life Care Intelligence Network (2012) Deaths from liver disease implications for end of life care

NHS Employers (2011) Agenda for change pay. Available at: http://www.nhsemployers.org/your-workforce/pay-and-reward/pay/agenda-for-change-pay [accessed 4 August 2015]

NHS Knowledge and Skills Framework. Available at: www.nhsemployers.org/PayAndContracts/AgendaForChange/KSF/Simplified-KSF/Pages/SimplifiedKSF.aspx.[accessed 4 August 2015]

NICE (2012) Hepatitis B & C - ways to promote and offer testing PH43 NICE: London.

NICE (2014) Obesity identification, assessment and mangement of overweight and obesity in children, young people and adults CG 189 NICE: London. Available at: https://www.nice.org.uk/guidance/cg189 [accessed 29 June 2015]

NICE guidelines. Available at: www.nice.org.uk/guidancemenu/conditions-and-diseases/liver-conditions [accessed 4 August 2015]

NMC (2015) Revalidation. Available at: http://www.nmc.org.uk/standards/revalidation/ [accessed 4 August 2015]

NMC: London.

Nursing Times Learning Unit. Liver Disease: risk factors and treatment. Available at: http://www.nursingtimes.net/online-nurse-training-courses/ [accessed 4 August 2015]

(Please note this resource is free to access but registration is required)

RCN (2009) Integrated core career and competence framework for registered nurses, RCN London. Available at: www.rcn.org.uk/__data/assets/pdf_file/0005/276449/003053.pdf [accessed 4 August 2015]

RCN (2010) Principles of Nursing Practice, RCN: London Available at: www.rcn.org.uk/development/practice/principles [accessed 4 August 2015]

Roach M S (1992) The human act of caring. Ottawa Canadian Hospitals Association

Skills for Health Career Framework. Available at: www.skillsforhealth.org.uk/workforce-transformation/customised-career-frameworks-services [accessed 4 August 2015]

Willians R., Aspinall R., Bellis M., et al Addressing Liver Disease in the UK: a blueprint for attaining excellence in healthcare and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity and viral hepatitis, Lancet 2014, 38:1953-97. Available at: http://www.thelancet.com/commissions/crisis-of-liver-disease-in-the-UK [accessed 4 August 2015]

70


Appendix 5: Useful contacts

American Association for the Study of Liver Disease (AASLD)

www.aasld.org/Pages/Default.aspx

Autoimmune patient support group

www.autoimmunehepatitis.org.uk

British Liver Nurses Forum (BLNF)

http://www.britishlivertrust.org.uk/health-professionals/british-liver-nurses-forum/

British Society of Gastroenterology (BSG)

www.bsg.org.uk

British Association of the Study of the Liver (BASL)

www.basl.org.uk

British Association of the Study of the Liver Nurse Forum (BASLNF)

www.basl.org.uk

British Liver Trust (BLT)

www.britishlivertrust.org.uk

Children’s Liver Disease Foundation (CLDF)

www.childliverdisease.org

European Association for the Study of Liver Disease (EASL)

http://www.easl.eu/discover

Liver4life

www.liver4life.org.uk

PBC Foundation

http://www.pbcfoundation.org.uk/

Royal College of Nursing Gastrointestinal Nursing Forum

www.rcn.org.uk/development/communities/rcn_forum_communities/gastro_and_stoma_care

The Hepatitis C Trust

www.hepctrust.org.uk

71


Appendix 6: The six Cs and how they fit into Caring for people with liver disease: a competence framework for nursing

Getting staffing right Enabling knowledge, skills and attitudes that are required to develop person centred liver care

Positive staff experience Improving knowledge and skills to develop quality care, teaching other members of the MDT on the liver / gastroenterology ward, day care, outpatients, A & Es, medical admission units, urgent care centres, primary care and as a professional standard to which to aspire.

Strengthening leadership Working to support liver nurse leadership to integrate better pathways between primary and secondary care

Improving patient experience The expert liver nurse / team has knowledge and understanding of liver care and is able to offer more information to help people to understand their choices.

Measuring levels of patient care by improving nursing knowledge this should have a positive impact on patient care. For example day case paracentesis needs continuity of care, patient focus groups and patient experience at the heart of delivering world class care

Helping people to stay independent

better working partnerships between primary and secondary care enabling working towards earlier identification and end of life care planning

(Department of Health, 2013)

The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies

Revised edition

September 2015

Review date September 2017

RCN Online www.rcn.org.uk

RCN Direct www.rcn.org.uk/direct 0345 772 6100

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

020 7409 3333

Publication code: 004 983

Norgine Pharmaceuticals Ltd have provided financial support by way of sponsorship for the production and distribution of this framework. Norgine Pharmaceuticals Ltd had no editorial input into the content of this framework other than a review for medical accuracy.

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