Developing and Sustaining a Competent and Confident Clinical Workforce through Essential Clinical Competencies for Non-Registered Practitioners
Competency Title: Pressure ulcer Prevention and Management (January 2015)
Competency Leads: Glenn Smith, Clinical Nurse Specialist Nutrition and Tissue Viability
Nutrition and Tissue Viability Service
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Authors: Glenn Smith, Karen Barnett, Donna Baker - October 2013
How to use this Competency Framework
This Competency Framework has been developed to enable the assessment of clinical competence.
Definition of Competence
“A set of specific and detailed outcomes that need to be achieved in order to a] prove immediate competence in essential skills or b] aid personal and professional development in desirable skills. The competencies must incorporate knowledge, skill, behaviour and demonstration of how these all equate to personal professional accountability for competent care of the patient” (Barnett 2013).
This definition focuses attention on the importance of recognising individual personal responsibility and accountability to deliver high quality care. This means taking appropriate actions following clinical assessments to ensure care or treatment is personalised and is delivered with care and compassion.
Responsibilities
Competency Lead: to develop the competency statements using the agreed framework, develop and co-ordinate the delivery of any underpinning knowledge, prioritise staff groups requiring assessment, and undertake competency assessments where appropriate ensuring the outcome is recorded on the Trust’s Learning Management System.
Clinical Lead :to ensure that they and their registered staff are competent within their scope of practice. The clinical lead may undertake competence assessments themselves or delegate to Registrants who meet the requirements for assessor. The selection of an assessor will be based mainly on relevant experience and training. The following criteria should be considered:
• Amount of experience working in their role (minimum of two years)
• Experience of assessing and supervising others i.e. pre-registration students and/or qualified staff
• Successful completion of a local or nationally recognised practice educator qualification.
The clinical lead should also monitor compliance and ensure that essential competencies are recorded on the Trust’s Learning Management System and reviewed annually at appraisal. The clinical leads are professionally accountable to the Executive Director of Nursing and their relevant Professional Body.
Individual Registered Practitioner: to provide evidence of the achievement of each competence and ensure that they maintain competence within their scope of practice and are reviewed annually at appraisal. Individuals are professionally accountable to the Executive Director of Nursing and their relevant Professional Body.
Assessor: to facilitate an environment conducive to learning, judge that the evidence provided/demonstrated meets the competence safely, effectively and consistently to the required standard and provide feedback to develop practice further
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Process of Competency Assessment – Non-Registered Practitioners
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Name: / Role: / Band:Work Base:
First Assessor Name and Role: / Second Assessor Name and Role:
Competency Statement
(Core Competencies to be included in all Competency Assessments) / Expected Level of Competency / Evidence Types: DO=direct observation; QA=questions and answers; RD=reflective discussion; WR=written records; WS=witness statements / Signature of Assessor
Non-Registered Practitioner delivers person centred care with sensitivity and compassion respecting the dignity and diversity of patients, relatives, carers, visitors and colleagues. / During this assessment the NRP is observed acting with respect, kindness, compassion and sensitivity. Demonstrates consistent person centred care with very good professional conduct/behaviour in line with trust expectations.
Non-Registered Practitioner gains consent for all interventions and maintain confidentiality as per trust policy while providing accurate and meaningful verbal information in a polite and respectful manner to patients, relatives, visitors and colleagues. / During this assessment the NRP consistently uses helpful strategies to enable people to understand the interventions in order to give informed consent. During this assessment the HCA is able to consistently communicate safely, sensitively and effectively using appropriate methods according to the situation.
Non-Registered practitioner completes documentation in accordance with Organisational standards. / During the assessment the NRP is observed practicing or is able to explain the standards for documentation applicable to the Trust
E.g. Accurately and contemporaneously with dates, times and signatures.
Non-Registered Practitioner demonstrates a awareness of limitations and the need to maintain an open and honest approach. / During the assessment the NRP consistently recognises and works within the limitations of their knowledge, skills and understanding their responsibility and accountability for their own actions and omissions.
Non-Registered Practitioner demonstrates how to safeguard vulnerable adults and children, and when to raise identified concerns through the appropriate channels. / During the assessment the NRP is observed or is able to recognise and respond correctly when people are in vulnerable situations, at risk or in need of support and protection.
Competency Statement
Subject Specific Competencies / Expected Level of Competency / Evidence Types: DO=direct observation; QA=questions and answers; RD=reflective discussion; WR=written records; WS=witness statements / Signature of Assessor
Non-registered practitioners demonstrate an understanding of pressure shearing and friction and their effects on the skin / Can describe each force separately and can describe how the skin is damaged by each force.
Non-registered practitioners understand the Waterlow risk assessment scale and EPUAP grading of pressure ulcers, and NATVN grading of moisture lesions / Can describe how Waterlow relates to the clinical risk of the patient developing pressure ulcers. Can briefly describe EPUAP grading of pressure ulcers including the term ungradable and NATVN grading of moisture lesions. Can articulate expected difference in appearance between pressure ulcers and moisture lesions.
Non-registered practitioners recognise skin changes that indicate skin breakdown and what they need to do about their findings / Non-registered practitioner describes common precursors to skin breakdown (pain, numbness, pins and needles, blanching erythema) and their responsibility to record and report their findings to their senior nurse
Non-registered practitioners can recognise other sources of pressure which may cause skin breakdown. / Can verbalise other sources of pressure such as masks, medical devices, splints, bandaging, plastercasts, footwear, anti-embolism stockings, catheters, NG tubes
Non-registered practitioners understand the difference between pressure relieving and pressure reducing devices. / Can articulate the difference in the way that pressure relieving and pressure reducing devices manage patients’ pressure areas, and which are most appropriate for which risk level
Non-registered practitioners understand their responsibility to registered nurses regarding pressure ulcer risk management / Can describe their responsibilities to carry out the prescribed care, report changes, and describe when there has been barriers to carrying out the care required. Can articulate limits of their role with regard to grading pressure ulcers, Waterlow scoring, assessing mental capacity, and care planning.
Non-registered practitioners understand the influence of patients’ mental capacity on their pressure area care. / Can articulate when they would respect patients’ choice, and when they would be required to provide care in the patient’s best interest.
Non-registered practitioners can describe the influence of other nursing factors on skin integrity / Can articulate the effects of continence, pain and nutrition on skin damage, and what nursing care they can provide to mitigate these issues.
Non-registered practitioners can demonstrate good repositioning technique which minimises pressure on bony prominences and maximises pressure relief / Demonstrates appropriate 30 degree tilt technique and how to check that pressure areas are free from contact with support surface. Can demonstrate good understanding of head position and heel elevation. Demonstrates good use of heel elevation and protection devices such as Repose and Parafricta bootees. Can articulate an understanding of minimum repositioning frequency.
Non-registered practitioners can demonstrate a good understanding of basic skin care requirements. / Demonstrates appropriate use of continence aids where used, barrier creams and films, and appropriate washing and cleansing technique.
Non-registered practitioner can demonstrate wound measurement and documentation skills / Demonstrates effective and consistent wound measurement technique using approved care plans, and effective description of wound size, shape, location, wound bed condition, and surrounding skin condition. Can articulate limits of their role in relation to documentation.
Assessment Outcome – Please sign in relevant box
Initial Assessment / Assessor Signature and date
2nd Assessment / Assessor Signature and date
3rd Assessment
Green / Pass - All essential competencies evidenced. / No action required. Review annually at appraisal. Revisit any development learning points listed below as recommended by assessor.
Red / Refer - One or more competencies not evidenced. / Clinical practice in relation to the specific competency not evidenced is to be supervised and reassessed within 2 weeks.
Learning points to revisit following successful competency assessment:
First Assessors Signature: Non-Registered Practitioners Signature:
Date:
Action Plan following referral at FIRST assessment. To be completed following this assessment in preparation for second assessment.
PART 1
First assessor to tick, initial and date once completed
o Outcome of assessment and feedback given to non-registered practitioner Initial: Date:
o Line manager informed of referral at first assessment Initial: Date:
o Non-Registered Practitioner signposted to further underpinning knowledge/ Competency Lead Initial: Date:
First Assessors Signature: Non-Registered Practitioners Signature:
ACTION PLAN
PART 2
Individual Learning Plan between line manager and Non- Registered Practitioner. To be completed following this assessment in preparation for second assessment.
Date for re-assessment:
Line Managers Signature: Non-Registered Practitioners Signature:
Action Plan following referral at SECOND assessment. To be completed following this assessment in preparation for final assessment.
PART 1
Second Assessor to tick, initial and date once completed
o Outcome of assessment and feedback given to non-registered practitioner Initial: Date:
o Line manager informed of referral at first assessment Initial: Date:
o Non-Registered Practitioner signposted to further underpinning knowledge / competency Lead Initial: Date:
Second Assessors Signature: Non-Registered Practitioners Signature:
ACTION PLAN
PART 2
Individual Learning Plan between line manager and Non-Registered Practitioner. To be completed following this assessment in preparation for final assessment
Date for Reassessment:
Line Managers Signature: Non-Registered Practitioners Signature:
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