Pilgrimage Competencies

Pilgrimage competencies

Introduction:

This document is designed to provide those responsible for the organisation of pilgrimages with a framework of clinical competencies that may be required on the pilgrimage. This includes both pilgrimage directors and their clinical leaders. It is written with UK Diocesan Pilgrimages to Lourdes in mind, as these have a relatively large proportion of sick pilgrims for whom there is an implict duty of care.

It is intended that a pilgrimage leadershipteam would use this document to review the care competencies that their own pilgrimage will require, andensure that these are met within the clinical team attending the pilgrims. By definition, all pilgrimages will involve travel, and most will result in pilgrims with care needs being away from their home environment. However pilgrimages vary widely in the number of pilgrims and their care requirements, as well as the individual pilgrims, the duration of pilgrimage and the method of travel, so competencies required will be vary with each pilgrimage episode as well as with each pilgrimage organisation.

For many pilgrimages, the majority of pilgrims are elderly, and will present with the common co-morbidities of this age group. For others, the majority of pilgrims will be long-term disabled adults or young people, and for some, there will be a number of pilgrims with terminal conditions.

Although no single specialty within medicine or nursing practice is a match for the competencies that may be required, the framework below uses as a basis the RCGP competence framework, adapted and supplemented with nursing care and travel competencies.

Using this Document:

It is for those responsible for providing clinical care to determine what is required for their pilgrimage and satisfy themselves that they meet these needs. This task will fall to the Pilgrimage Directors guided by their Clinical Leads, who may use this framework to identify and articulate these needs clearly. It should be used during the planning of the pilgrimage, and prior to the acceptance of pilgrims with unusual or specific needs that are not commonly seen.

It is not envisaged that any single clinician, whether doctor, nurse or other, will possess all or even the majority of the competencies identified as required, but that the pilgrimage should identify the competencies required for a particular pilgrimage episode, and ensure these can be met from within the clinical team, or that there are robust escalation plans in place.

Given that clinical teams provide the majority of their care outside the UK or Ireland, for many acute presentations,escalation to the French medical system is the most appropriate pathway.For most chronic conditions, referral to the pilgrim’s usual clinical team on return is appropriate.

Where a competence is likely to be common to most or all pilgrimages, this is highlighted in bold italics in the framework. If this competence is not required, it may be helpful to document why this is not necessary, in order that there is evidence that it was appropriately considered.

Competencies that are deemed necessary should be noted on the framework, as well as the way they will be met. This may be through individual clinicians (IC), by the whole clinical team (CT), or by an escalation plan (EP).

The term clinical team has been used, rather than doctor, nurse or other professional label, to reflect that in the pilgrimage situation, clinical care is delivered through a team-based approach, with individual members acknowledged as having their own strengths, but none standing separately from the others.

Below is an example of what a completed competence for diabetic care on a young person’s pilgrimage might look like:

In this example it is decided that the whole clinical team needs to be aware of which pilgrims are diabetic, and so they will be briefed on this. The challenges of clinical care will be well understood by the nurses on the pilgrimagewho are paediatrically trained, and the CMO will provide further advice about managing the pilgrims during the journey. There are no adult pilgrims with diabetes, so cardiovascular complications have been deemed unlikley to occur, and marked not applicable.

Domain 13: Metabolic Problems
Pilgrimage requirement / Who / How Met
Competence: Presentation
Understand the prevalence of diabetes in a pilgrimage population / Yes / EC / Briefing day
Understand the challenges of managing diabetes particular to certain groups e.g. children and adolescents, those with mental health problems, those with dementia / Yes / IC / Professional practice of paediatric nurses
Understand the impact that the journey may have on diabetic control / Yes / IC / Paediatric nurses and pilgrimage CMO
Be aware of the potential for complications of diabetes to occur, in particular cardiovascular disease. / N/A / N/A / Only children on pilgrimage

This then provides evidence of how clinical care was planned for any likely clinical event. It can also be used to inform the pilgrimage insurers that risk was being actively managed.

Over time this competence framework can be used to identify training requirements for the pilgrimage as well as continuing professional development (CPD) for participating clinicians. This will in turn feed into their professional revalidation.

Clinical Modules:

There are 19 clinical domains in this framework, The first is for the pilgrimage leadership team who are planning the pilgrimage to consider, the remainder refer to clinicians or to clinical leaders. Domain 20 is an extra sheet that may be used to asses and document the safe provision of care in cases where there are pilgrims with needs not articulated elsewhere in the domains. These may represent complexity or particular disease processes that are rare.

1. Clinical Governance
2. Promoting Health and Preventing Disease
3. Care of Acutely Ill People
4. Care of Children and Young People
5. Care of Older Adults
6. End-of-Life Care
7. Care of People with Mental Health Problems
8. Care of People with Intellectual Disability

9. Cardiovascular Health

10. Respiratory Health

11. Digestive Health and Infection Prevention and Control

12. Care of People with Visual and Hearing Problems

13. Care of People with Metabolic Problems

14. Care of People with Neurological or Musculoskeletal Problems

15.Skin Care and Tissue Viability.

16. Substance Abuse

17. Manual Handling

18. Medicines Management

19. Travel Medicine

20. Specific Pilgrim’s Care