RCN Pain Knowledge and Skills Framework for the Nursing Team
This publication is supported by the pharmaceutical industry RCN Pain Knowledge and Skills Framework for the Nursing Team
Felicia Cox 1 (Chair), Karin Cannons 2 and Sarah Lewis 2 on behalf of the working party for the Royal College of Nursing (RCN) Pain and Palliative Care Forum. Working Party Contributors Dr Donna Brown Denise Everett Sue Jenkins Janet Roberts Rachel Townsend Steve Ward Thanks to Professor Nick Allcock, Dr Emma Briggs, Amanda Cheesley, Dr Gillian Chumbley, Dr Fiona Duncan, Tanis Hand, Professor Alison Leary, Nik Payne, Professor Kate Seers, Professor Patricia Schofield, Gill Simon, Christine Waters, New Zealand Pain Society Nurses’ Interest Group, The Royal College of Nursing and all reviewers. No competing interests have been declared. Consultation This document was circulated widely and hosted on RCN webpages during the one month consultation period. The circulation list included RCN Fora, Royal Colleges, Professional Colleges, organisations supporting people with pain and specialist pain nursing networks in the UK, Ireland and New Zealand. Endorsement This document is endorsed by the British Pain Society.
Dissemination plan The nursing co-ordinator will be responsible for dissemination to professional and patient organisations and ensuring that the current document version is available for download from RCN webpages. Previous versions will be archived adhering to RCN policy.
Supported by an educational grant from Grünenthal Ltd UK. This publication is supported by the pharmaceutical industry.
1 Royal College of Nursing and British Pain Society 2 Royal College of Nursing
2 RCN Pain Knowledge and Skills Framework for the Nursing Team
Contents Foreword 4 Glossary 5 Rationale and approach 6 Framework summaries 9 Guide for implementation 11 Knowledge and skills framework for unregistered staff 12 Unregistered staff understanding pain 13 Unregistered staff pain assessment 15 Unregistered staff physical strategies to manage pain 17 Unregistered staff self-management strategies 19 Unregistered staff pharmacological strategies 21 Unregistered staff interventional strategies 23 Unregistered staff service development 25 Unregistered staff complex pain management 26 Knowledge and skills framework for registered nurses 28 Registered nurse understanding pain 29 Registered nurse pain assessment 32 Registered nurse physical strategies to manage pain 34 Registered nurse self-management strategies 37 Registered nurse pharmacological strategies 40 Registered nurse interventional strategies 42 Registered nurse service development 44 Registered nurse complex pain management 46 References 48
3 RCN Pain Knowledge and Skills Framework for the Nursing Team
Foreword
Assessing and managing pain are essential components of nursing practice. Pain is often categorised as acute or chronic, but it is a complex physical, psychological and social phenomenon that is uniquely subjective. A key fundamental of nursing care, patients continue to report unrelieved pain during procedures, after surgery, during episodes of acute illness, in the community and in care homes. Pain traverses all clinical settings and the age spectrum, yet is often poorly assessed and managed by nurses. This results in short and long-term adverse consequences. Article three of the International Association for the Study of Pain (IASP) Declaration of Montreal (IASP 2010) cites the right of all people with pain to have access to appropriate assessment and treatment of the pain by adequately trained health care professionals. Poorly managed acute pain may result in the development of chronic pain which is known to have a strong association with anxiety, depression, quality of life and the ability to sleep, communicate and work. The key common findings of surveys of chronic pain inform us that one in five people of all ages have moderate to severe chronic pain and one-third of individuals of working age who have chronic pain have lost the ability to perform wage-earning or other work (IASP 2011). The Royal College of Nursing (RCN) has launched this document in all four UK countries simultaneously. The content has been endorsed by the British Pain Society (BPS) and has been presented at the 2015 European Federation of IASP Chapters (EFIC) meeting. It is hoped that this framework document will enable a common understanding and terminology to develop, so that levels of competency can be understood across the nursing continuum in all four countries. Designed to be adapted for local use by individual staff members, this framework should be of great practical use for employers when it comes to writing role descriptions and conducting performance reviews; and for employees needing to evidence their competency, on-going development and assert their fitness to practice during professional revalidation.
Felicia Cox Chair, RCN Pain and Palliative Care Forum
4 RCN Pain Knowledge and Skills Framework for the Nursing Team
Glossary
Interdisciplinary team (IDT) – team consisting of nursing, physiotherapy, pharmacy, psychology, occupational therapy and medical colleagues. This team contains specialists with expert skills in pain assessment, functional performance and medicines management. The IDT can help patients understand their pain-related thoughts, emotions and behaviours. Pain – an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP 2012). Registered – a registered nurse, health visitor or midwife who has completed a qualification, is competent and on the Nursing and Midwifery Council (NMC) register. Unregistered – a member of the nursing team (supervised by a registered nurse) providing health and social care to patients. Unregistered staff may be employed as a care assistant, health care support worker or associate/assistant practitioner.
5 RCN Pain Knowledge and Skills Framework for the Nursing Team
Rationale and approach
The Royal College of Nursing (RCN) is the major professional body for nursing in the United Kingdom (UK). The RCN Knowledge and innovation action plan for 2014-2018 (RCN 2014) aims to develop new knowledge and evaluate its impact. The action plan supports identifying and helping to fill gaps in standards, guidance and knowledge resources for nursing staff. The publication of Pain after surgery (RCS 1990) spearheaded the need for the implementation and development of acute pain services in the UK. At that time, few hospitals had an acute pain service nor nurses specialising in pain management. Professor Kate Seers represented nursing on this working party and we are grateful that she contributed to a panel discussion in 2013 organised by the RCN Pain and Palliative Care Forum. This event was chaired by Professor Nick Allcock and the panel consisted of expert pain educationalists, academics, researchers and specialist nurses. It was convened to develop a strategy to identify pain-related learning needs of the nursing team. Contributors included nurse representatives of patients from vulnerable groups including older people, those in secure settings or diagnosed with a learning disability. The panel agreed that there was a need to produce supportive educational materials to facilitate an enhanced awareness of the importance of the assessment and management of pain. The panel agreed two work streams. The first was to produce accessible information about pain in an EasyRead format for people with a learning disability. A separate working party convened to produce EasyRead information on pain; after surgery, epidural analgesia and patient controlled analgesia (PCA). These were launched in June 2015 at RCN Congress. The second work stream was to develop this framework. Prior to the publication of this document, there were no nationally agreed standards, competencies or frameworks for pain management nursing in the UK. This RCN-funded project focused on developing a knowledge and skill framework (KSF) to improve the understanding and skill set of the wider nursing team; to promote excellence in practice thus improving patient care and outcomes. It is anticipated that this project and the publication of this KSF will also help shape health policy by raising the profile of pain through political lobbying. This KSF aims to provide a framework that supports the development of competence in managing pain for the entire nursing team; from care assistants to nurse consultants. The framework contains the eight aspects of care identified at the roundtable discussion, such as pain assessment and interventions as well as seven dimensions, for example, nursing responsibility. It has been designed to be used alongside local competency documents and illustrates Benner’s vision of individual nurse’s migration from novice to expert (Benner 1984). There is clear progression in the knowledge, practice and experience of nursing staff working within the framework. Firstly the career framework (Skills for Health 2010) is mapped against both Benner’s levels of performance (novice, advanced beginner, competent, proficient, expert). These two, in turn, are mapped against levels of education across the spectrum from care certificate through to doctoral studies. Content has been split to meet the specific needs of unregistered and registered members of the nursing team. Each staff group has their own framework summary based on Benner’s 1982 novice to expert levels of practice (Table 1) mapped against levels one to eight (excluding director level) of the Skills for Health Career Framework (SFH 2010) illustrated in Figure 1. The framework summary for unregistered staff is shown in Figure 2 and for registered nurses in Figure 3.
6 RCN Pain Knowledge and Skills Framework for the Nursing Team
Table 1: From novice to expert concept (Adapted from Benner 1982)
Skill and practice level Explanatory notes
Novice A beginner with no experience. They are taught general rules to help perform activities, and their rule-governed behaviour is limited and inflexible. They are told what to do and follow instruction working within protocols and guidelines.
Advanced beginner Shows acceptable performance, and has gained prior experience in actual nursing situations. This helps the nurse* recognise recurring meaningful components so that principles, based on those experiences, begin to formulate in order to guide actions.
Competent Has two or three years’ experience in the same field. The experience may also be similar day-to-day situations. These nurses* are more aware of long-term goals, and they gain perspective from planning their own actions, which helps them achieve greater efficiency and organisation.
Proficient Perceives and understands situations as whole parts. Has a more holistic understanding of nursing, which improves decision-making. These registered nurses learn from experiences what to expect in certain situations, as well as how to modify plans as needed.
Expert No longer relies on principles, rules, or guidelines to connect situations and determine actions. They have a deeper background of experience and an intuitive grasp of clinical situations. Their performances are fluid, flexible, and highly-proficient.
* Nurse refers to all members of the nursing team.
7 RCN Pain Knowledge and Skills Framework for the Nursing Team
Figure 1: Skills for Health Career Framework (SFH 2010) Key elements of the career framework
Career framework level 9 People working at level 9 require knowledge at the most advanced frontier of the field of work and at the interface between fields. They will have responsibility for the development and delivery of a service to a population, at the 9 highest level of the organisation. Indicative or reference title: director. Career framework level 8 People at level 8 at the career framework require highly specialised knowledge, some of which is at the forefront of knowledge in a field of work, which they use as the basis for original thinking and/or research. They are leaders with considerable responsibility, and the ability to research and analyse complex processes. They have responsibility for service improvement or development. They may have considerable clinical and/or management responsibilities, be accountable for service delivery or have a leading education or commissioning role. 8 Indicative or reference title: consultant
Career framework level 7 People at level 7 of the career framework have a critical awareness of knowledge issues in the field and at the interface between different fields. They are innovative and have a responsibility for developing and changing practice and/or 7 services in a complex and unpredictable environment. Indicative or reference title: advanced practitioner. Career framework level 6 People at level 6 require a critical understanding of detailed theoretical and practical knowledge, are specialist and/or have management and leadership responsibilities. They demonstrate initiative and are creative in finding solutions to problems. They have some responsibility for team performance and service development and they consistently 6 undertake self-development. Indicative or reference title: specialist/ senior practitioner.
Career framework level 5 People at level 5 will have a comprehensive, specialised, factual and theoretical knowledge within a field of work and an awareness of the boundaries of that knowledge. They are able to use knowledge to solve problems creatively, make judgements which require analysis and interpretation and actively contribute to service and self-development. 5 They may have responsibility for supervision of staff or training. Indicative or reference title: practitioner.
Career framework level 4 People at level 4 require factual and theoretical knowledge in broad contexts within a field of work. Work is guided by standard operating procedures, protocols or systems of work, but the worker makes judgements, plans activities contributes to serviced development and demonstrates self-development. They may have responsibility for supervision 4 of some staff. Indicative or reference title: assistant/ associate practitioner.
Career framework level 3 People at level 3 require knowledge of facts, principles, processes and general concepts in a field of work. They may carry out a wider range of duties than the person working at level 2 and will have more responsibility, with guidance and supervision available when needed. They will contribute to service development and are responsible for 3 self-development. Indicative or reference title: senior health care assistants/ technicians.
Career framework level 2 People at level 2 require basic factual knowledge of a field of work. They may carry out clinical, technical, scientific or administrative duties according to established protocols, procedures or systems of work. 2 Indicative or reference title: support worker.
Career framework level 1 People at level 1 are at entry level and require basic general knowledge. They undertake a limited number of straightforward tasks under direct supervision. They could be any new starter to work in the health sector and progress 1 rapidly to level 2. Indicative or reference title: cadet. Copyright Skills for Health 2010. All rights reserved.
8 RCN Pain Knowledge and Skills Framework for the Nursing Team
Framework summaries
In 2013 the Nurses’ Interest Group of the New Zealand Pain Society published a pain management nursing knowledge and skills framework (KSF) for registered nurses (NZPS 2013). This well-designed but lengthy document provided a starting point for the development of this document. Permission was given to adapt the pictorial representation of the KSF. It was agreed by the working party that competent would be the highest level of performance for unregistered staff, whilst competent would also be the lowest level of performance for registered nurses. This is demonstrated by the use of the same term (competent) and corresponding content of the eight aspects of care. See Figures 2 and 3. Figure 2: Framework summary unregistered staff
9 RCN Pain Knowledge and Skills Framework for the Nursing Team
Figure 3: Framework summary for registered nurses
FRAMEWORK SUMMARY REGISTERED NURSE
Career 5 Framework 6 7 & 8
Level of practice Competent Proficient CompetentExpert (Benner)
System Culture Interdisciplinary Team (IDT)
Aspects of care Dimension
• Awareness of painful • Nursing responsibilities conditions • Elements of nursing care • Holistic pain assessment • Interpersonal • Physical strategies Person responsibilities • Self-management strategies • Interdisciplinary Individual • Pharmacological strategies Family healthcare, research Cultural • Interventional therapies Friends and quality Biological • Service development Environment • Ethical standards Psychological • Complex Pain management Work • Escalation of care Spiritual • Assessment
Level of professional Registration/ Post-graduate Masters Doctorate qualification first degree courses
Attribute Communication Person centred Evidence Ba sed Co Comp Leadership Advocacy Influence ll aboration Courage Equality Ethical Practice care as sion
Adapted with permission from © The New Zealand Pain Society (2013) New Zealand Pain Management Nursing Knowledge and Skills Framework.
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10 RCN Pain Knowledge and Skills Framework for the Nursing Team
Guide for implementation
This document, which includes two aspects of care summaries, is designed to guide and support the demonstration of competence by the nursing team when caring for people with pain, thus ensuring transferable excellence in pain management. The frameworks are not intended to be a didactic list of boxes to tick, but a signpost to: • act as a development tool for graded clinical skills that can be used throughout nursing careers to structure and collate evidence for a personal portfolio of knowledge and clinical skills • provide evidence for local professional development and performance reviews • provide a structure to develop education programmes • to provide a framework by which pain specialist nurses can not only measure educational and clinical skills but also their effectiveness • place emphasis on self-directed learning • facilitate critical reflection on clinical experiences • promote self-directed learning strategies.
No framework can be universally applicable. It is anticipated that each local area or practitioner will adapt the materials to their own needs and then review at a mutually agreed interval between the employing organisation and the staff member. Suggestions for implementation include that the staff member: • has a supervisor, assessor or mentor that has already fulfilled their competencies • works with that person regularly • identifies and agrees targeted level of practice with supervisor, assessor or mentor • works within specified time lines for aspects of nursing care competencies • gathers, collates and presents evidence to meet specific criteria or identified knowledge or skills requirement • documents learning and skills for review by assessor with subsequent discussion of all relevant sections • uses framework to guide learning and development with assessor as part of their performance review/appraisal.
11 RCN Pain Knowledge and Skills Framework for the Nursing Team
Knowledge and skills framework for unregistered staff
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16 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Clinical observation.Clinical observation. on Feedback of trainingEvidence and education. reflections. Personal withDiscussion supervisor. observation.Clinical observation. on Feedback of trainingEvidence and education. withDiscussion supervisor. Setting of objectives. Appraisal. audit. for Data collection Escalation of care Knows when to when to Knows seek support from senior. issues Recognises and utilises agreed protocols issues escalate to that arise. Ethical Standards Ethical Identifies and works and Identifies ofwithin sphere own practice. the need Recognises have all patients to for the provision to access strategies. of physical issues Understands of safeguarding patients and patient information. work and Identifies ofwithin sphere own practice. issues Understands and importance of patients safeguarding information. patient and Interdisciplinary health care, Interdisciplinary health care, and quality research Identifies the role ofrole the team other Identifies members. of an understanding Has policy practice. that guides and experience knowledge Has of supporting and staff patents strategies utilising physical within holistic their pain management. of understanding Shows policy practice.that guides Interpersonal Interpersonal Responsibilities Listens, observes, learns, learns, observes, Listens, to participates and responds others. effectively Communicates and other family with patient, ofmembers the team. strategies physical Explores within evidence base. of ways engaging Identifies patients. and empowering turning and positioning support wound devices reach heat and cold massage mobilisation exercise. turning and positioning support wound devices reach heat and cold massage mobilisation exercise ofrole physiotherapy hydrotherapy TENS.
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17 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. audit Collect and analyse data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Knows when to when to Knows assistance request seniors. from in Raises issues quality to relation and service with development line manager. Ethical Standards Ethical Identifies and works and Identifies ofwithin sphere own practice. knowledge In-depth of issues safeguarding patient and for information. and supportsPraises staff junior other members. Interdisciplinary health care, Interdisciplinary health care, and quality research Has detailed knowledge of detailed knowledge Has the of and responsibilities roles within professionals health care the team. policies that guide Utilises guide to practice as a resource own practice and advise patients. Interpersonal Interpersonal Responsibilities Accesses and utilises evidence and utilises Accesses discuss based to guidelines the purpose and recognises of the benefits and limitations strategies and is able physical discuss withto patient. of ways engagingExhibits patients and empowering ofin the utilisation physical strategies. turning and positioning support wound devices reach heat and cold massage mobilisation exercise ofrole physiotherapy hydrotherapy TENS. range of movement, and strength muscle stamina activitycardiovascular pain relief weight and appetite management activities of living daily sleep mood.
Describes how the followingDescribes how strategies aid pain physical as: such management • • • • • • • • • • • • • • • • • Elements ofElements care nursing In the context of: the context In Demonstrates a Demonstrates ofgood knowledge ofexamples physical strategies with empower patients to these utilise to them to appropriately maintain and improve function within activities of daily living. monitors Actively ofthe effectiveness methods physical and strategies and integrates different aspects of practice to for outcomes improve patients. Nursing Nursing responsibilities Level of practice Competent Level 4 Dimension
18 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. ofEvidence training/education. withDiscussion supervisor. Observation of practice with feedback. ofEvidence training/education. withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Seeks support and appropriately care escalates when senior to own recognises limitations. issues Recognises agreed and applies to protocols problems escalate to in relation self-management strategies that as a occur may ofresult their intervention(s). Ethical standards Ethical of within sphere own Works practice. the need for Recognises access have all to patients of the provision to self- education management of issues Understands and patients safeguarding patient information. works and within Identifies ofsphere own competence. the need for Recognises access have all to patients of the provision to self- education. management Information to Adherence Governance. Interdisciplinary health and quality research care, of how an awareness Has interventions care nursing to contribute may self- promoting strategiesmanagement as part of the IDT. the abilityDemonstrates part in take actively to self-management promoting strategies as at a basic level part of the IDT. Interpersonal Interpersonal responsibilities in which Discusses ways can be self-management optimised. a concept Demonstrates of self-management how strategies can be optimised within the of clinical context practice. promoting movement promoting anxietyreducing comfort improving facilitating sleep distraction family. involving Elements ofElements care nursing to care nursing Uses reduce movement, promote comfort, improve anxiety, and sleep, restful facilitate distractionencourage to help self-manage pain. of the different aware Is of the role in which ways can be self-management pain by: chronic used for • • • • • • Nursing responsibilities Nursing of difference Awareness and chronic acute between and physical pain including effects. psychological an awareness Demonstrates differs of chronic how pain and the acute from plays self-management role the in helping improve and psychological physical impact of pain. Dimension Level of practice Novice 1 and 2 Levels Advanced beginner Level 3 Unregistered staff self-management strategies self-management staff Unregistered with engage patients to strategies enabling self-management managing to for acute contribute team the nursing describesThis domain how pain. and chronic
19 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. ofEvidence training/education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Recognises issues issues Recognises agreed and applies to protocols problems escalate to in relation self-management strategies that as a occur may ofresult their intervention(s). the health Within history identifies such situations as complex pain history, ideation suicidal cognitive or which dysfunction, a more require may comprehensive and assessment management. Escalation of care Recognises own limitations Recognises engaging withwhen actively strategiesself-management within work own to in order of sphere practice. the need for Recognises access have all to patients of the provision to self- education management whether this be patient or directed. clinician Information to Adherence Governance. Ethical standards Ethical Actively takes part and takes Actively promoting to contributes strategiesself-management as part of the IDT. rationaleDiscusses clinical the self-management for strategies the for chosen they have patient and how been applied. documents Accurately with and communicates any personnel the relevant chosen to related outcomes strategies. Interdisciplinary health and quality research care, Applies knowledge knowledge Applies patient facilitate to self- in adopting strategiesmanagement pain optimise their to management. level patient’s Assesses of ability apply to these strategies and knowledge facilitates ofand understanding pain pain and related beliefs, behaviour, goals and expectations, highlighting these how their to contribute may pain. Interpersonal Interpersonal responsibilities Identifies the different the different Identifies acute in which ways pain can be and chronic of and the role managed self-management. confidence Displays in guiding the patient self-management to strategies by; promoting reducing movement, improving anxiety, facilitating sleep, comfort, distraction and involving the family. Elements ofElements care nursing Demonstrates an Demonstrates ofunderstanding how from differs chronic pain and discusses acute the rationale the role for plays self-management the in helping improve and psychological physical impact of pain. potential Identifies self- barriers effective to management. the impact ofAssesses the on the interventions and psychological physical wellbeing of the patient. Nursing responsibilities Nursing Competent Level 4 Dimension
20 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. withAssist audit data collection. withDiscussion supervisor. Setting of objectives. Appraisal. Observation of practice with feedback. of training/Evidence education. withDiscussion supervisor. Assessment Recognises and Recognises to uses protocols escalate appropriately problems potential in relation seniors to signs clinical and to symptoms of adverse effects. Learns to recognise, and recognise, Learns to escalates appropriately potential seniors, to in relation problems pharmacological to strategies are which and or not working side-effects. producing Escalation of care Accepts and documents and documents Accepts right decline to patients’ analgesia. up to knowledge Keeps date. Works within relevant Works legislation and local operating standard procedures. Articulates the importance of patient safeguarding information. Ethical standards Ethical Contributes to, to, Contributes and understands the importance of, audit – the continuous and safety ofeffectiveness pharmacological strategies. Demonstrates continuous continuous Demonstrates more learning from with staff, experienced evidence on an emphasis the based practice from start. the Learns about importance of continuous and qualitydata collection improvement. Interdisciplinary health and quality research care, Listens and responds to to and responds Listens practitioner. the novice others. Learns from simple and clear Gives instructions patients to about pain relief under supervision. that an awareness Has impact medicines may capacity. mental Listens, learns, and learns, Listens, others. to responds Interpersonal Interpersonal responsibilities Administers commonly commonly Administers prescribed pharmacological strategies under supervision. of routes awareness Has of administration and side effects of used commonly ofmedicines in the area practice. Assists withAssists the administration of pharmacological strategies supervision direct under as appropriate (www.nmc-uk.org/ publications/standards). of routes awareness Has of administration and side effects of used commonly ofmedicines in the area practice. Elements ofElements care nursing Demonstrates, with Demonstrates, of knowledge guidance, medications including non- analgesia, allergies, the over prescribed drugs, alcohol drugs, counter intake. and tobacco Observes and reports ofthe effectiveness pharmacological pain relieftherapies for effects side including guidance. direct under Nursing responsibilities Nursing Novice 1 and 2 Levels Advanced beginner Level 3 Level of practice Aspect ofAspect care Unregistered staff pharmacological strategies strategies pharmacological staff Unregistered use of timely and appropriate pharmacological therapies. the safe, to contributes team the nursing how This aspect explores
21 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. audit Collect and analyse data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. clinical signsclinical and symptoms of adverse effects when to knows help from request colleagues. senior
Recognises and Recognises to uses protocols escalate appropriately in problems potential to: relation Escalation of care • • Supports junior when theycolleagues or report incidents concerns. Aware of of the roles Aware the regulatory agencies in medicine use, involved and licensing monitoring the National example (for of and Institute Health the Excellence, Clinical Safety on Committee and local of Medicines, formulary committees). Ethical standards Ethical Assists in the development in the development Assists and guidelines of protocols of treatment for side effects and complications withassociated pharmacological strategies. with closely Works pharmacy and other health care relevant professionals. Interdisciplinary health and quality research care, Listens and responds to to and responds Listens juniors. others. Learns from the skills Develops simple and give to instructionsclear for care, patients in their and at discharge. that Recognises impact medicines may capacity. mental Interpersonal Interpersonal responsibilities Takes responsibility for for responsibility Takes management day-to-day of using care routine pharmacological strategies. the therapeutic Knows uses of the medication its be administered, to side- normal dosage, and precautions effects, contraindication. the dosage, Considers appropriate where weight, method of administration, and timing. route Elements ofElements care nursing Takes histories to include include to histories Takes efficacy, drug ranges, ofside-effects medication to and intolerance analgesia. and Evaluates articulates a clear rationale the choice for of pharmacological strategies. of potential any Aware signs and symptoms/ contra-indication of pharmacological strategies. effects adverse Manages and and completes maintains accurate documentation. Nursing responsibilities Nursing Level of practice Competent Level 4 Aspect ofAspect care
22 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. withDiscussion supervisor. Observation of practice. Feedback. of education Evidence training. Discussion. Appraisal. Escalation of care seek when to Knows seniors. support from and issues Recognises utilises agreed protocols that issues escalate to arise. Ethical standards Ethical of within sphere Works own practice. the Understands importance of the health safeguarding and wellbeing of patients. Information to Adheres Governance. of within sphere Works competence. Describes the importance of the health safeguarding and wellbeing of patients. Information to Adheres Governance. Interdisciplinary health and quality research care, of an awareness Has policies guiding practice. policies Understands guiding practice as a guide to resource clinical staffown/junior practice advise patients. and to Discusses how Discusses how patients can actively engage in their pain management interventions. Communicates with effectively families and patients, within the IDT. ways Demonstrates engage actively to patients with their pain interventional care. management Communicates with effectively families and patients, within the inter-disciplinary (IDT).team Interpersonal Interpersonal responsibilities Awareness of the needs Awareness of patients with advanced techniques analgesic those undergoing or pain for a procedure management. the needs ofAssesses patients with advanced techniques analgesic those undergoing or pain for a procedure management. Elements ofElements care nursing Observes the ofeffectiveness pain for interventions Completes management. documentation. accurate and provides Evaluates a rationale the on ofeffectiveness an manages intervention, effects simple adverse accurate and completes in documentation records. clinical and Effectively and monitors safely a patient manages undergoing appropriate a pain management intervention. Nursing responsibilities Nursing Level of practice Novice 1 and 2 Levels Beginner Advanced Level 3 Dimension Unregistered staff interventional strategies interventional staff Unregistered and maintain function. This aspect of of improve the role outlines to interventions care
23 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. withAssist audit data collection. withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care in issues Escalate patients to relation serviceor to delivery as required. managers awareness Demonstrate of patient safety how the widerlinks into organisation. Ethical standards Ethical of within sphere Works own practice. the Integrates importance of the safeguarding and well being of patients undergoing pain management interventions. Information to Adheres Governance. Interdisciplinary health and quality research care, policies guiding Use practice as a clinical own/ guide to resource staffjunior practice and to advise patients. Role model who Role with engages actively patients with complex in their pain issues care. interventional Communicates with effectively families, patients, IDT. Interpersonal Interpersonal responsibilities Demonstrates the abilityDemonstrates prepare, effectively to and manage assess, the needs ofevaluate a pain patients undergoing management intervention. Elements ofElements care nursing Evaluates and articulates Evaluates rationale the a clear on and effectiveness choice of an intervention. effects adverse Manages accurate and completes in documentation records. clinical articulate to Able responses physiological pain interventional to techniques. management Nursing responsibilities Nursing Level of practice Competent Level 4 Dimension
24 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. withDiscussion supervisor. Observation of practice with feedback. of training/Evidence education. withAssist audit data collection. withDiscussion supervisor. Setting of objectives. Appraisal. Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care seek when to Knows senior. support from and the courage Has any ability escalate to line direct to concerns manager. with effectively Works define clearly to others and direction values, policies including to how on guidance when these respond or pressure under are in conflict. are interests Ethical standards Ethical works and Identifies ofwithin sphere own practice. works and Identifies ofwithin sphere own practice. within own Works of sphere influence ensuring services are patient centered. Interdisciplinary health and quality research care, and Understanding of the serviceawareness to provided provision individual areas. and Good understanding of the serviceawareness to provided provision individual areas. risks any Identifies withassociated the service and gives delivery suggestions constructive risk to any in reducing the service for improve and the public. users Interpersonal Interpersonal responsibilities observes, Listen, participates and learns, others. to responds with Communicates and family patient, of members other the team. Describes ways of engaging and patients empowering services. improve to of areas Identifies needseducational and service to contributes using by improvement and skills knowledge best practice. share to Elements ofElements care nursing of pain safe Awareness practice management adapting own practice as agreed. guidance Seeks support, instruction and accepts when necessary. pain safe Demonstrates practice management adapting own practice Seeks support, as agreed. and accepts guidance instruction when necessary. model in the as a role Acts improve to contribution the service employing by good communication skills. Provides patient- Provides ensuring care centered pain management withis addressed all patients. effectively Works with to others improve continually care pain management all patients. to offered situations Identifies of the scope where bepractice needs to the improve to expanded service. Nursing responsibilities Nursing Level of practice Novice 1 and 2 Levels beginner Advanced Level 3 Competent Level 4 Dimension Unregistered staff service development service staff Unregistered ensuring provision pain management of the development person-centered to This aspect contribute of team the nursing describes how care and education. research the use of audit,
25 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. withDiscussion supervisor. Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives Appraisal. Escalation of care seek when to Knows seniors. from assistance and issues Recognises agreed protocols applies problems escalate to complex to in relation pain. Identifies and works and Identifies ofwithin sphere own practice. the Understands importance of the health safeguarding and wellbeing of patients. Information to Adheres Governance. works and Identifies ofwithin sphere own practice. Information to Adheres Governance. Ethical standards Ethical Has an understanding of an understanding Has local policies that guide practice. the abilityDemonstrates assist other effectively to ofmembers the IDT. the individual Aware needs of a patient with (or pain living with) complex family. and their an Demonstrates ofunderstanding local policies that guide practice. the abilityDemonstrates effectivelyto support of members other the IDT. the needs ofRecognises individual with patients living(or with) complex family. pain and their Interdisciplinary health and quality research care, Discusses ways in Discusses ways patients can which in their be assisted ofunderstanding pain management. Communicates with effectively families and patients, of members other the IDT. ways Demonstrates can patients in which in their be assisted ofunderstanding pain management. Communicates with effectively families and patients, of members other the IDT. Interpersonal Interpersonal responsibilities Awareness of patients Awareness self-manage to unable pain. their the patient Assesses pain with complex a range ofacross clinical circumstances. Supports and encourages self-management strategies. Elements ofElements care nursing Assesses pain and Assesses documents accurately findings. Supports patients undertaking self- management approaches. to tools suitable Chooses pain and assess complex documents accurately findings. Nursing responsibilities Nursing Level of practice Novice 1 and 2 Levels beginner Advanced Level 3 Understanding pain Understanding Unregistered staff complex pain management pain complex staff Unregistered of individualised management care care and responsive holistic between assessment patient the relationship on focuses This domain the importance ofemphasising and self-management. communication
26 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice. team from Feedback members/mentor. of education Evidence training. from Evidence education/training (assessments). performance Individual review. reflections. Personal Escalation of care in issues Escalates complex to relation pain with nursing and clinicians staff, managers. situations Identifies as suicidal such that requires ideation comprehensive a more and seeks assessment as refers or advice appropriate. Identifies and works and Identifies ofwithin sphere own practice. Adheres to Information Governance. the Integrates importance of the safeguarding health and wellbeing of daily patients into practice. Ethical standards Ethical Good understanding ofGood understanding local policies that guide practice. withCollaborate IDT to biopsychosocial provide pain management. Interdisciplinary health and quality research care, Role model who Role engages actively patients and their families with complex pain issues. Communicate with patients, effectively families and IDT. Interpersonal Interpersonal responsibilities Undertakes a Undertakes biopsychosocial ofassessment a patient pain. with complex the effect of self- Evaluate approaches. management Elements ofElements care nursing . St. Louis: Mosby; 1999. Mosby; Louis: St. clinical. manual Pain: Evaluates and articulates Evaluates rationale a clear on and effect the choice of a pain management strategy. the potential Interprets signsclinical and symptoms of complex case management. effects adverse Manages accurate and complete in documentation records. clinical is patient Ensure undertaking self- strategiesmanagement appropriately. Nursing responsibilities Nursing asero C, McCaffery M. M. McCaffery C, asero P Level of practice Competent Level 4 Understanding pain Understanding
1
27 RCN Pain Knowledge and Skills Framework for the Nursing Team
Knowledge and skills framework for registered nurses
FRAMEWORK SUMMARY REGISTERED NURSE
Career 5 Framework 6 7 & 8
Level of practice Competent Proficient CompetentExpert (Benner)
System Culture Interdisciplinary Team (IDT)
Aspects of care Dimension
• Awareness of painful • Nursing responsibilities conditions • Elements of nursing care • Holistic pain assessment • Interpersonal • Physical strategies Person responsibilities • Self-management strategies • Interdisciplinary Individual • Pharmacological strategies Family healthcare, research Cultural • Interventional therapies Friends and quality Biological • Service development Environment • Ethical standards Psychological • Complex Pain management Work • Escalation of care Spiritual • Assessment
Level of professional Registration/ Post-graduate Masters Doctorate qualification first degree courses
Attribute Communication Person centred Evidence Ba sed Co Comp Leadership Advocacy Influence ll aboration Courage Equality Ethical Practice care as sion
Adapted with permission from © The New Zealand Pain Society (2013) New Zealand Pain Management Nursing Knowledge and Skills Framework.
28
10 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Escalates issues in issues Escalates pain to relation and anatomy with physiology nursing and clinicians staff, managers. Escalation of care Identifies and works and Identifies ofwithin own sphere practice. the Integrates importance of the and safeguarding wellbeing of patients diagnosticundergoing investigations. Information to Adheres Governance. the Understands importance of the and safeguarding wellbeing of patients. Ethical standards Ethical Describes specific may which investigations aid diagnosis of pain. documents Accurately data/ and communicate findings relevant with health personnel. Interdisciplinary health and quality research care, Assesses the patient the patient Assesses and family’s knowledge/ ofunderstanding their pain. approach Modifies patients according to the characteristicsto of pain their when performing observations and assessments. that Recognises impact medicines may capacity. mental Interpersonal Interpersonal responsibilities cardiovascular and cardiovascular respiratory systems gastrointestinal system musculoskeletal system endocrine system genitourinary system development of (persistent) chronic pain.
Elements ofElements care nursing • • • • • • Identifies examples with Identifies clinical to relevant practice the potential effects ofadverse pain of: the perspective from nociceptive pain nociceptive pain neuropathic visceral pain somatic pain. anxiety depression fear/avoidance spirituality quality of life.
• • • • • • • • • Describes of the role the nervous system in the transduction, perception transmission, ofand modulation pain. Describes with examples knowledge fundamental and chronic of acute, pain and of: cancer Nursing responsibilities Nursing the potential Identifies ofrelationship the the person’s following to ofexperience pain: Competent Competent 5 Level Level of practice Dimension Registered nurse understanding pain understanding nurse Registered physiology. and anatomy associated its and pain of at definition the looks aspect of This care pain? is What
29 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Comprehensively Comprehensively discusses and escalates to in relation issues anatomy pain diagnosis, withand physiology clinicians staff, nursing and managers. Escalation of care Demonstrates abilityDemonstrates to of withinwork sphere own practice. the Demonstrates importance of the and safeguarding wellbeing of patients diagnosticundergoing investigations. Information to Adheres Governance. the Understands importance of the and safeguarding wellbeing of patients. Ethical standards Ethical Actions specific Actions may which investigations aid diagnosis of pain. documents Accurately data/ and communicate findings with IDT and health personnel. other Interdisciplinary health and quality research care, Assesses and informs Assesses and the patient knowledge/ family’s ofunderstanding their pain. Specifically adapts patients to approach the to according characteristics of their pain when performing and observations, when assessments planning treatment. Interpersonal Interpersonal responsibilities cardiovascular and cardiovascular respiratory systems and gastrointestinal genitourinary systems metabolic an neuroendocrine systems. wind-up (hyperalgesia and allodynia) mood activities of daily living (ADLs).
Elements ofElements care nursing • • • • • • • Discusses the potential Discusses the potential and physiological adverse effects ofpsychological pain and persistent acute of: the perspective from Discusses these in the of: context nociceptive pain nociceptive pain neuropathic visceral pain somatic pain. sensation emotion cognition cultural and social, environmental factors.
• • • • • • • • Demonstrates an in- Demonstrates of knowledge depth the model ofbiopsychosocial to pain and relationship pain behaviours. knowledge Demonstrates of the pathophysiology ofand psychology acute, pain and cancer chronic and of: Nursing responsibilities Nursing ofDiscusses the concept pain as a whole and the practice for implications that involves: Proficient Level 6 Level of practice Dimension
30 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. Design and implement audit and research projects. service Ensure follows best pain practice for the across assessment range of groups patient conditions. and clinical reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Expertly discusses issues and escalates pain to in relation anatomy diagnosis, withand physiology clinicians, staff, nursing and the widermanagers arena. health care appropriate Initiates to in response referrals abnormal findings and that patients ensure up followed are appropriately. Escalation of care Demonstrates precision precision Demonstrates withinin working ofsphere own practice. shortcomings Identifies in the service delivery. and develops Evaluates, strategicimplements plans. Information to Adheres Governance. the Understands importance of the and safeguarding wellbeing of patients. Ethical standards Ethical Orders specific Orders and investigations physical conducts may which examination aid diagnosis of pain. documents Accurately data/ and communicate other findings with IDT, and the health personnel arena wider health care national, via the local, and international ofdissemination research and audit results. Interdisciplinary health and quality research care, Acts as a role model as a role Acts and teach guide to staff health care other about the rationale incorporating for a biopsychosocial/ to spiritual approach pain management. Critically analyses and adapts approach patients according to the characteristicsto of pain their when performing observations, and assessments when planning and implementing treatment. Interpersonal Interpersonal responsibilities cardiovascular and cardiovascular respiratory systems and gastrointestinal genitourinary systems metabolic an neuroendocrine systems. wind-up (hyperalgesia and allodynia) mood activities of daily living (ADLs).
Elements ofElements care nursing Expertly evaluates adverse the potential and physiological effects ofpsychological pain and persistent acute of: the perspective from • • • • • • • Considers these in the Considers of: context Demonstrates knowledge knowledge Demonstrates and comprehensive ofunderstanding the pain. patient’s as evidencedExperience the successful by ofcompletion a post- in pain graduate course including management and anatomy diagnosis, ofphysiology pain. leadership Demonstrates ofin the utilisation a biopsychosocial/ pain to spiritual approach in practice. management Nursing responsibilities Nursing Expert 7 and 8 Levels Level of practice Dimension
31 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Escalates issues in issues Escalates pain to relation with assessment nursing and clinicians staff, managers. the health Within history identifies as such situations pain problem/ complex ideation/ suicidal memory that require problems comprehensive a more and seek assessment as refers or advice appropriate. Escalation of care Negotiates and Negotiates a implements culturally responsive individualised plan management that incorporates a biopsychosocial pain to approach management. Documents timeline of reassessment for pain and evaluation of pain management interventions. evaluates Accurately ofeffectiveness the plan pain management in partnership with in pain the person and communicates required amendments health appropriate to personnel. Ethical standards Ethical Discusses clinical rationaleDiscusses clinical in the investigations for ofassessment the person with pain. documents Accurately data/ and communicates findings relevant with health personnel. Interdisciplinary health and quality research care, Assesses the patient the patient Assesses and family’s knowledge/ understanding its of pain, their factors, contributing goals beliefstheir and expectations treatment surrounding preferences. and their Interpersonal Interpersonal responsibilities Identifies social Identifies withpopulations challenges potential assessment to and demonstrates knowledge fundamental of assessment appropriate where frameworks/tools practice. to relevant Elements ofElements care nursing Discusses the rationale of assessment for pain as a multi-dimensional and the experience barriers that can occur. valid and reliable Uses assessing and for tools measuring pain. the Demonstrates ability undertake to pain a fundamental history. a focused Performs assessment. physical the impact ofAssesses pain on interventions and function. Nursing responsibilities Nursing Competent Competent 5 Level Level of practice Dimension Registered nurse pain assessment pain nurse Registered communicated. and assessed,measured is pain how outlines aspect of recognised. This care is pain How
32 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. audit projects on Lead and participate in research. reflection Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Observation of practice with feedback. of training/Evidence education. Design and implement audit and research projects. service Ensure follows best pain practice for the across assessment range of groups patient conditions. and clinical reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Comprehensively Comprehensively discusses and escalates to in relation issues withpain assessment clinicians staff, nursing and managers. the health Within history identifies as such situations pain problem/ complex ideation/ suicidal memory that require problems comprehensive a more and seeks assessment as refer or advice appropriate. Escalation of care Comprehensively discusses and escalates to in relation issues withpain assessment clinicians, staff, nursing and the widermanagers arena. health care appropriate Initiates to in response referrals abnormal findings and that patients ensure up followed are appropriately. Negotiates and Negotiates a implements culturally responsive individualised plan management that incorporates a biopsychosocial pain to approach management. Documents timeline of reassessment for pain and evaluation of pain management interventions. evaluates Accurately ofeffectiveness the plan pain management in partnership with in pain the person and communicates required amendments health appropriate to and services.personnel Ethical standards Ethical and Comprehensively critically evaluates ofeffectiveness pan management at agreed interventions modifies up, follow and/or plan/therapy accordingly, referrals and communicates staff/ with appropriate services. Demonstrates rationaleDemonstrates laboratory appropriate for in response investigations clinical patient’s to condition. Discusses rationale for specific radiological as part ofinvestigations diagnostic up. work recognition Demonstrates of abnormal laboratory and identifies results, and explanation potential pain for the implications therapy. management Interdisciplinary health and quality research care, model to as a role Acts other and teach guide staffhealth care about the importance of identification assessment, possible and where management appropriate of risk in the health factors history. in-depth Demonstrates ofknowledge the clinical rationale laboratory for and radiologicaltests in response investigations clinical patient’s to abnormal presentation, and results/findings treatment. for implications Within the health Within history identifies actual potential or pain-related for depression, anxiety, fear catastrophising, behaviour, avoidance pain, persistent medication misuse/ self-harm and abuse, abuse. the patient/ Assesses beliefs about family’s strategies, coping pain, expectations, management, treatment preferences, of knowledge goals, and condition their cause or its likely factors contributing in their role and their pain management. Interpersonal Interpersonal responsibilities model to as a role Acts other and teach guide staffhealth care about the importance of a pain comprehensive the approaches history, taking this and to ofthe formulation diagnosis differential pain the complex for patient. the patient Assesses and family’s ofknowledge pain and provides individualised information and as education appropriate. Demonstrates proficiency proficiency Demonstrates in the use of appropriate for frameworks/tools special as populations and relevant required the practice for to ofassessment pain. a Undertakes pain comprehensive history gather health to inform data and to diagnosisnursing cross a range of pain complex presentations. Elements ofElements care nursing a Completes pain comprehensive history gather to and critically analyse and objective subjective inform health data to diagnosis differential a range of across complex pain presentations. Demonstrates knowledge knowledge Demonstrates and of the rationale for, barriers assessment to and evaluation of pain the perspective from of health professionals, and family patient, general public. a focused Performs assessment. physical valid and reliable Uses the population for tools assess and measure to pain and function. the impact ofAssesses pain on interventions and function. Nursing responsibilities Nursing Demonstrates in the use ofleadership frameworks/ appropriate to relevant tools practice for clinical the comprehensive ofassessment pain. a focussed Completes assessment. physical Proficient Level 6 Level of practice Expert 7 and 8 Levels Dimension Level of practice
33 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. ofEvidence training/education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Knows when to request request when to Knows seniors. from assistance in relation Raises issues quality and serviceto with line development manager. Escalation of care Identifies and Identifies withinworks ofsphere own practice. In-depth ofknowledge safeguarding patient for issues and patient information. and Praises supports other staffjunior members. Ethical standards Ethical Has detailed knowledge of detailed knowledge Has and responsibilities the roles of professionals health care within the team. policies that guide Utilises to practice as a resource own practiceguide and advise patients. Interdisciplinary health and quality research care, Accesses and utilises and utilises Accesses evidence based guidelines discuss the purposeto the benefits and recognise and limitations of physical strategies to and is able discuss with patient. of ways engagingExhibits patients and empowering ofin the utilisation strategies. physical Interpersonal Interpersonal responsibilities turning and positioning support wound devices reach heat and cold massage mobilisation exercise ofrole physiotherapy hydrotherapy TENS. range of movement, and strength muscle stamina cardiovascular activity pain relief weight and appetite management activities of daily living sleep mood.
• • • • • • • • • • • • • • • • • Elements ofElements care nursing of: the context In Describes how the Describes how following physical strategies aid pain as: such management Nursing responsibilities Nursing Demonstrates a goodDemonstrates ofknowledge examples strategiesof physical with empower to patients these utilise to them improve to appropriately and maintain function within activities of daily living. the monitors Actively ofeffectiveness physical methods and strategies and integrates different aspects of practice to for outcomes improve patients. Understanding pain Understanding Competent Level 5 Level of practice Registered nurse physical strategies to manage pain manage to strategies physical nurse Registered pain. and persistent in acute function maintain and to improve strategies physical of importance the outlines aspect of This care
34 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. ofEvidence training/education. audit on Lead and projects participate in research. reflection. Personal withDiscussion supervisor. Setting of objectives Appraisal. Escalation of care Confidently and Confidently integrates efficiently therapies into such practice or clinical appropriate more where seniors. to refers shortcomings Identifies in service provision strategic enhance to development. discusses and Records, patient any escalates safety service or issues with issues delivery line manager. Ethical standards Ethical In partnershipIn with and patients disciplines other sound makes that are decisions ethically-based in the interest of patients in the absence of previous or experience protocols. Demonstrates ability work to ofwithin sphere own practice. Demonstrates a high of level ofknowledge safeguarding patient for issues and patient information. Supports junior staff members. Interdisciplinary health and quality research care, Acts as a resource and as a resource Acts of the benefits promotes interdisciplinary team collaboration. in development Participates of and policies guidelines practice. clinical for to and presents back Feeds the wider team. Interpersonal Interpersonal responsibilities Accesses and utilises and utilises Accesses evidence based guidelines discuss the purposeto the and recognises benefits and limitations strategiesof and physical discuss with to is able patient. of ways engagingExhibits patients and empowering of utilisation in their strategies. physical physiological pathological psychological elements. acupuncture biofeedback rehabilitation other approaches.
• • • • • • • Elements ofElements care nursing the effects on Recognises pain. unrelieved and teaches Demonstrates on knowledge an in-depth strategies above physical and: to assessment Utilises an appropriate provide plan. pain management Discusses the characteristics between capacity and function in physiological to relation and psychological attributes. Discusses, utilises and Discusses, and the patients teaches, interdisciplinary team and improving why maintaining function is important in pain in relation management to: Nursing responsibilities Nursing Demonstrates where best where Demonstrates practice and evidence base has been applied practice in or clinical to of knowledge depth role and a wide variety of strategies the for physical ofmanagement pain. the explain to Able rationale of therapies used and discusses the benefits and limitations. Understanding pain Understanding Level of practice Proficient Level 6
35 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. ofEvidence training/education. Design and audit implement and research projects. serviceEnsure best practice follows pain assessment for the range ofacross and patient groups conditions. clinical reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Comprehensively Comprehensively discusses and provides information and to referral on resources services for appropriate functional assessment and management. Ethical standards Ethical Demonstrates Demonstrates in precision withinworking ofsphere own practice. Appreciates and evaluates ethical diversity in developing strategies for ethical approaches in cultural withingroups patients and staff members. Identifies shortcomings in the service delivery. Evaluates, and develops implements strategic plans. Interdisciplinary health and quality research care, Demonstrates effective effective Demonstrates skills. leadership Independently and a nursing establishes interdisciplinary team training programme on strategies. physical the importanceIntegrates of and patients safeguarding all patient information into practice. clinical influence Demonstrates strategies physical into and service from delivery national and international evidence and practice. withCollaborates expert at a groups working national and regional, level. international Interpersonal Interpersonal responsibilities Provides thorough thorough Provides with patient consultation about the and family importance of using strategies physical in managing pain to and maintain improve function. advanced Has skills. communication Discusses advanced evidence-based knowledge with and the patients interdisciplinary team. the to Contributes development of publicising pain by and disseminating developments. activities of daily living functional different activities incorporating behavioural cognitive into interventions those functional activities activity tolerance sleep and sleep hygiene – social, relationships and intimate sexual work. to returning
• • • • • • • Elements ofElements care nursing this knowledge Utilises practice and in clinical others teaching Demonstrates a Demonstrates level comprehensive of and knowledge ofunderstanding nature the essential of and improving maintaining function in to: relation Nursing responsibilities Nursing Demonstrates an Demonstrates of level advanced clinical making.decision competing Manages adverse demands, effects and completes comprehensive documentation. solutions new Generates that best meet the needs through of the patient, thinking and lateral evidence base. Understanding pain Understanding Level of practice Expert 7 and 8 Level
36 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. audit Collect and analyse data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Recognises issues issues Recognises agreed and applies escalate to protocols in relation problems self-management to strategies that may of as a result occur their intervention(s). the health Within history identifies as such situations pain history, complex or ideation suicidal dysfunction, cognitive a require may which comprehensive more and assessment management. Ethical standards Ethical Recognises own Recognises whenlimitations engaging withactively self-management strategies in order within work own to of sphere practice. the need Recognises have all patients to for the provision to access of self-management whethereducation this clinician be patient or directed. works and Identifies ofwithin sphere own practice. Adheres to Information Governance. Interdisciplinary health and quality research care, Actively takes part and takes Actively promoting to contributes self-management strategies as part of the IDT. Discusses clinical rationale the self- for strategiesmanagement the patient for chosen been they have and how applied. documents Accurately with and communicates personnel the relevant to related outcomes any strategies.chosen Interpersonal Interpersonal responsibilities Applies knowledge knowledge Applies patient facilitate to in adopting self-management strategies to pain optimise their management. level patient’s Assesses of ability apply to these strategies and knowledge facilitates and understanding of pain and related pain behaviour, goals and beliefs, expectations, highlighting how contribute these may pain. their to Elements ofElements care nursing Identifies the different the different Identifies acute in which ways pain can be and chronic of and the role managed self-management. confidence Displays in guiding the patient self-management to strategies by; promoting reducing movement, improving anxiety, facilitating comfort, distraction and sleep, the family. involving Nursing responsibilities Nursing Demonstrates an Demonstrates ofunderstanding how from differs chronic pain and can acute discuss the rationale self- the role for plays management in helping improve and the physical impact psychological of pain. potential Identifies self- barriers effective to management. the impact Assesses of the interventions and the physical on wellbeing psychological of the patient. Dimension Level of practice Competent 5 Levels Registered nurse self-management strategies self-management nurse Registered pain. chronic and acute managing for strategies with self-management to engage patients to enabling contribute team nursing describes the how domain This
37 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Support and enable Support and enable risk to management maximise independence whilst and choice patient promoting safety. Discusses and escalates with to issues regards self to management clinicians staff, nursing and managers. Ethical standards Ethical Ensures individuals are individuals are Ensures informed make to able their manage to choices needs. self-care and Negotiate a implement culturally responsive individualised plan management a that incorporates approach biophysical pain management. to works and Identifies ofwithin sphere own practice. Adheres to Information Governance. Interdisciplinary health and quality research care, Ensures on-going on-going Ensures supported by follow-up both patient to feedback team and health care of self-management interventions. Interpersonal Interpersonal responsibilities Communicates Communicates enable to effectively assess their patients to needs and develop and gain confidence self-manage. to of own values Aware and beliefs and the put be to able own values patient’s and beliefs at the ofcentre supporting self-management. the Assesses patient/family’s beliefs about pain, strategies, coping expectations, management, ofknowledge their and condition cause or its likely factors contributing in their role and their pain management. Elements ofElements care nursing Demonstrates knowledge knowledge Demonstrates and understanding use shared to in how help making to decision bethe patient in control of and condition their quality of life. Nursing responsibilities Nursing Demonstrates Demonstrates ofknowledge the and rationale for, in barriers success to using self-management the from techniques, ofperspective health professionals, care and family patient, general public. evidence based Uses improve principles to practice. Demonstrates using by knowledge and approaches tools that support shared self- making for decision management. the impact ofAssesses pain on interventions and function. Dimension Level of practice Proficient Level 6
38 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of advanced Evidence training/education. Design and implement projects. audit and research service best Ensure follows pain assessment practice for the range ofacross patient and clinical groups conditions. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Comprehensively Comprehensively discusses and escalates self- to in relation issues strategiesmanagement with the IDT and wider team. health care Ethical standards Ethical Critically evaluates and beliefsown values and is willing put to and values the patient’s beliefs at the centre of supporting self- management. works and Identifies ofwithin sphere own practice. Adheres to Information Governance. Interdisciplinary health and quality research care, Collaborates closely with closely Collaborates of members other the as psychologists ICT such health mental and other ensure to professionals for care and effective safe all patients. effectiveness Evaluates of self-management strategies and contributes regional and local, to national health care agenda. Interpersonal Interpersonal responsibilities Communicates Communicates reinforce expertly to to behaviours helpful patient enhance and confidence self-esteem. model as a role Acts and teach guide to staff health care other about the importance of self-management and behavioural approaches. Elements ofElements care nursing Expert in the use of self- strategiesmanagement patients and coaching coping optimise their to skills. gaps in Identifies and knowledge patient’s abilities. in excellence Promotes facilitates sleep hygiene, pacing and challenges destructive or unhelpful and values beliefs, behaviours. Nursing responsibilities Nursing Demonstrates expertDemonstrates of use knowledge to how change health behaviour theories and strategies. expertDemonstrates of use knowledge to how skills, patients existing strategiescoping and strengths. Dimension Level of practice Expert 7 and 8 Level
39 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Observation of practice with feedback. of training/Evidence education. audit projects on Lead and participate in research reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Clinical signsClinical and symptoms of effects adverse when to Knows help from request colleagues seniors Supports junior when colleagues they report or incidents concerns.
• • • Escalation of care Recognises and acts Recognises appropriately/takes the lead in relation signs clinical to: and symptoms of effects from adverse interventions. Recognises and Recognises to uses protocols escalate appropriately in problems potential to: relation Ethical standards Ethical Has a good Has ofunderstanding ofthe roles the regulatory agencies in drug involved and monitoring use, example (for licensing Institute the National of Excellence, Clinical on the Committee Safety of Medicines, and the Medicines products Healthcare and Agency Regulatory local formularies and Committees. Aware of of the roles Aware the regulatory agencies in medicine involved monitoring use, (for and licensing the National example of and Institute Health the Excellence, Clinical Safety on Committee and local of Medicines, formulary committees). Interdisciplinary health and and quality research care, Proactively develops develops Proactively for and guidelines protocols oftreatment effects and side associated complications with pharmacological strategies. Discusses all aspects of pharmacological strategies with the interdisciplinary team. Assists in the development in the development Assists and guidelines of protocols of treatment for effects side associated and complications with pharmacological strategies. with closely pharmacy Works health relevant and other professionals. care Interpersonal Interpersonal responsibilities Teaches others. Teaches detailed Gives re explanations pharmacological strategies both staff to and patients. that Recognises medicines may impact mental capacity. Listens and responds and responds Listens juniors. to others. Learns from the skills Develops simple and give to instructionsclear for care, patients in their and at discharge. that Recognises medicines may impact mental capacity. Elements ofElements care nursing Exhibits confident and confident Exhibits decision- independent making. Supports patients own pain taking their relief and able where appropriate. titration careful Initiates and individualization of regimens. dose non- independent An medical prescriber with of knowledge the and pharmacokinetics ofpharmacodynamics medicines used in a wide range of settings. Takes responsibility for for responsibility Takes management day-to-day of using care routine pharmacological strategies. the therapeutic Knows uses of the medication its be administered, to normal dosage, precautions side-effects, and contraindication. the dosage, Considers and where weight, method ofappropriate and route administration, timing. Nursing responsibilities Nursing Independently evaluates evaluates Independently and articulates a clear rationale the choice for of pharmacological strategies. of potential any Aware signs and symptoms/ contra-indication of pharmacological strategies. manages Independently effects when adverse and appropriate and maintains completes documentation. accurate Takes histories to to histories Takes drug ranges, include side-effects efficacy, of medication and analgesia. to intolerance and Evaluates articulates a clear rationale the choice for of pharmacological strategies. of potential any Aware signs and symptoms/ contraindication of pharmacological strategies. Understanding pain Understanding Competent Level 5 Proficient Level 6 Level of practice Registered nurse pharmacological strategies pharmacological nurse Registered pharmacological therapies. of use appropriate and timely to the safe, nurses contribute how explores domain This
40 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. Design and implement audit and research projects. service Ensure follows best pain practice for the across assessment range of groups patient conditions. and clinical reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Recognises and acts Recognises appropriately/taking the lead in relation signs clinical to: and symptoms of effects from adverse interventions. Ethical standards Ethical In depth knowledge knowledge depth In of of the roles the regulatory agencies in drug involved and monitoring use, example (for licensing Institute the National of Excellence, Clinical on the Committee Safety of Medicines, and the Medicines products Healthcare Agency Regulatory and local formularies committees. Interdisciplinary health and and quality research care, Leads on the development the development on Leads and guidelines of protocols of treatment for effects side associated and complications with pharmacological strategies. organisation- on Leads wide audit and research pharmacological to related interventions. withCollaborates local, national and regional, expert international working groups. Interpersonal Interpersonal responsibilities Develops and Develops leads teaching organisation- wide analgesic on pharmacological strategies. that Recognises medicines may impact mental capacity. Elements ofElements care nursing An independent non- independent An medical prescriber of knowledge Advanced and the pharmacokinetics ofpharmacodynamics medicines used in a wide range of settings. Nursing responsibilities Nursing Delivers complex care at care complex Delivers level. an advanced Understanding pain Understanding Level of practice Expert 7 and 8 Level
41 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice. Feedback. of education Evidence training. Discussion. Appraisal. Observation of practice. Assessment Feedback. of education Evidence training. Discussion. Appraisal. Recognises issues and issues Recognises utilises agreed protocols that issues escalate to arise. Comprehensively discusses records, in issues and escalates safety patient to relation serviceor with delivery clinicians staff, nursing and managers. Escalation of care Demonstrates the Demonstrates withinability work to of sphere own practice. the health Integrates and wellbeing of patients undergoing pain management interventions. Information to Adheres Governance. Works within sphere of within sphere Works competence. Describes the importance of the health safeguarding and wellbeing of patients Information to Adheres Governance. Ethical standards Ethical Collaborates on on Collaborates ofdevelopment policies guiding practice. IDT about to Feedbacks pain management outcomes. intervention Use policies guiding Use practice as a clinical own/ guide to resource staffjunior practice and to advise patients. Interdisciplinary health and quality research care, Ability to act as a role act as a role to Ability model and actively withengage patients pain issues complex interventional in their pain management care. Communicate with effectively families, patients, MDT and managers. Independently and nursing deliver MDT interventional training and/ sessions programmes.or Role model who Role engages actively patients with complex in their pain issues care. interventional Communicates with effectively IDT families, patients, and managers. Interpersonal Interpersonal responsibilities
1 Demonstrates the abilityDemonstrates advanced provide to advice skills, knowledge, for and management a pain patients undergoing intervention. management Elements ofElements care nursing the abilityDemonstrates prepare, effectively to and manage assess, the needs ofevaluate patients undergoing a pain management intervention. Demonstrates clinical clinical Demonstrates on decision-making ofthe effectiveness an interprets intervention, clinical the potential signs and symptoms of therapies, interventional adverse manages effects and completes comprehensive in documentation records. clinical Independently, and safely effectively allmanage aspects of the complex for care patient undergoing a pain management intervention. Evaluates and articulates Evaluates rationale the a clear on and effectiveness choice of an intervention. effects adverse Manages accurate and completes in documentation records. clinical articulate to Able responses physiological pain interventional to techniques. management Nursing responsibilities Nursing Competent Level 5 Proficient Level 6 Level of practice Dimension Registered nurse interventional strategies interventional nurse Registered function. maintain and to improve of interventions role the outlines aspect of This care [1] Including but not limited to Patient Controlled Analgesia, Subcutaneous/intravenous infusions, neuraxial and regional anaesthesia & analgesia, injection, radiofrequency and neuromodulation. radiofrequency injection, neuraxial anaesthesia and regional & analgesia, infusions, Subcutaneous/intravenous Analgesia, Controlled Patient to not limited but [1] Including
42 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice. Feedback. of education Evidence training. Discussion. Appraisal. Escalation of care Comprehensively discuss and escalate in relation issues patient safetyto or service with delivery clinicians, staff, nursing and the widermanagers arena. health care Ethical standards Ethical precision Demonstrates withinin working of sphere own practice. integrate to Able the importance of the safeguarding health and wellbeing of daily patients into practice guiding others modelling best and role practice. Information to Adheres Governance. Interdisciplinary health and quality research care, and on Collaborates the development initiates of policies and guidelines pertinent practice. to audit and on Leads activities to research and evaluate measure, managers to feedback and the wider health care interventional on arena practice outcomes. influence Demonstrates the interventional on agenda. health care Interpersonal Interpersonal responsibilities model. as a role Acts expert Provides and care clinical engages actively patients (with pain issues complex co- and multiple morbidities) in their pain interventional care. management Communicates evidence advanced withbased knowledge IDT families, patients, at local, and managers regional and national settings. Elements ofElements care nursing the abilityDemonstrates expert clinical provide to skills and knowledge, patients for advice a pain undergoing intervention. management Demonstrates an Demonstrates of level advanced clinical as to decision-making the suitability of patients pain management for and the interventions outcomes. interprets Independently the clinical and manages signs and symptoms withassociated multiple and co-morbidities therapies. interventional competing Manages adverse demands, effects and completes comprehensive in documentation records. clinical Nursing responsibilities Nursing Level of practice Expert 7 and 8 Levels Dimension
43 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Observation of practice with feedback. of training/Evidence education. audit projects on Lead and participate in research. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care with effectively Works define clearly to others and direction values, policies including to how on guidance when these respond or pressure under are in conflict. are interests ensuring care Monitors staff meeting are Escalates objective. concerns. Ethical standards Ethical within own Works of sphere influence ensuring services are patient-centred. within a system Works that care ensures which an equal on is provided all and patients basis to is fully accessible. Identifies any risks any Identifies withassociated the service and gives delivery suggestions constructive risk to any in reducing the service for improve and the public. users with the others Evaluates ofeffectiveness service and improvements further action agrees any them take to required forward. Interdisciplinary health and quality research care Identifies areas of areas Identifies needseducational and service to contributes using by improvement and skills to knowledge best practice. share Constructively own role undertakes servicesin improving as agreed through appraisal continuous and supports others during times effectively of change. robust Develops programeducational pain and delivers management training all health to professionals care the throughout organisation. Interpersonal Interpersonal responsibilities Acts as a role model in the as a role Acts improve to contribution the service employing by good communication skills. of the development Leads high quality services by identifying values, team and policies. direction Elements ofElements care nursing Identifies situations situations Identifies of the scope where bepractice needs to the improve to expanded service. in innovation Interprets practice at local nursing and regional level. Nursing responsibilities Nursing Level of practice Competent Level 5 Proficient Level 6 Dimension Registered Nurse service development service Nurse Registered and research audit, of use the ensuring provision management pain of person-centered to development the contribute team nursing describes the how aspect of This care education.
44 RCN Pain Knowledge and Skills Framework for the Nursing Team Observation of practice with feedback. of training/Evidence education. Design and implement audit and research projects. service Ensure follows best pain practice for the across assessment range of groups patient conditions. and clinical reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Assessment Works in partnership Works with develop, to others and forward take of direction evaluates policies and strategies. resources for Lobbies supportto and develop pain services. Escalation of care Identifies own strengths Identifies to and utilises them the pain servicedevelop ofwithin sphere own practice. and applies Plans for ethical and professional manage to education patients in pain and in uses wider concepts and the professional to ethical literature practice. improve Supports and develops ofroles staff. Ethical standards Ethical Effectively engages the engages Effectively service users public, interested and other parties and in an open on; discussion effective policies direction, values, and strategies the for organisation/services. Interdisciplinary health and quality research care
service users wider public and colleagues co-workers GPs/CCGs people in other parts of the organisation agencies. other
• • • • • • Develops a common a common Develops vision of patient- and evidence- centred based services and and systems create this achieve to processes within liaison other of: groups Interpersonal Interpersonal responsibilities Plans for and applies and applies Plans for local/national policy that willinitiatives pain management change practice within staff team. pain a dynamic Promotes service to that responds and changes appropriate the staffmotivates team. Elements ofElements care nursing Communicates and Communicates innovations disseminates practice at in nursing national regional, local, level. and international Nursing responsibilities Nursing Expert 7 and 8 Level Level of practice Dimension
45 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. Collect and analyse audit data. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care in issues Escalates complex to relation pain with nursing and clinicians staff, managers. situations Identifies as suicidal such that requires ideation comprehensive a more and seeks assessment as refers or advice appropriate. Ethical standards Ethical works and Identifies ofwithin sphere own practice. Adheres to Information Governance. the Integrates importance of the health safeguarding and wellbeing of daily patients into practice. Interdisciplinary health and quality research care, Good understanding ofGood understanding that guide local Policies practice. withCollaborate IDT to biopsychosocial provide pain management. Interpersonal Interpersonal responsibilities Role model who Role patients engages actively families withand their pain issues. complex Communicate with patients, effectively IDT. families, Elements ofElements care nursing Undertakes a Undertakes biopsychosocial ofassessment a patient pain. with complex the effect Evaluates of self-management approaches. Nursing responsibilities Nursing Evaluates and articulates Evaluates rationale a clear on and effect the choice of a pain management strategy. the potential Interprets signsclinical and symptoms of complex case management. effects adverse Manages accurate and complete in documentation records. clinical patient Ensure (families and carers is appropriate) where undertaking self- strategiesmanagement appropriately. Understanding pain Understanding Level of practice Competent Level 5 Registered nurse complex pain management pain complex nurse Registered and research audit, of use the ensuring provision management pain of person-centered to development the contribute team nursing describes the how aspect of This care education.
46 RCN Pain Knowledge and Skills Framework for the Nursing Team Assessment Observation of practice with feedback. of training/Evidence education. audit projects on Lead and participate in research. reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Observation of practice with feedback. of training/Evidence education. Design and implement audit and research projects. service Ensure follows best pain practice for the across assessment range of groups patient conditions. and clinical reflection. Personal withDiscussion supervisor. Setting of objectives. Appraisal. Escalation of care Discusses and escalates to in relation issues pain with complex clinicians staff, nursing and managers. situations Identifies as suicidal such that requires ideation comprehensive a more and seeks assessment as refers or advice appropriate. Identifies complex complex Identifies as such situations ideation suicidal a more that requires and comprehensive expert and assessment as refers or seeks advice appropriate. Ethical standards Ethical works and Identifies ofwithin sphere own practice. Adheres to Information Governance. and implement to Able integrate the health and wellbeing of patients practice daily and into others. guide a Implements culturally responsive individualised plan to pain. complex manage Identifies and works and Identifies ofwithin sphere own practice. Adheres to Information Governance. Demonstrates effective consistent and clarityleadership in withworking patients pain with complex and Comprehensively critically evaluates pain management for interventions patients with complex pain. Interdisciplinary health and quality research care, Collaborates on on Collaborates ofdevelopment policies guiding practice. work and effectively Safely within the IDT. audit and on Leads engages with research activities measure, to to and feedback evaluate managers. Acts as role model to model to as role Acts other and teach guide staffhealth care about the importance of complex pain. an in Demonstrates of knowledge depth the rationale any for for required investigations the diagnosis and ongoing ofmanagement the patient with pain needs. audit and on Leads activities to research and evaluate measure, managers to feedback and the wider health care arena. influence Demonstrates with the patient on (or pain, living with) complex agenda. health care Interpersonal Interpersonal responsibilities Acts as a role model and as a role Acts patients engages actively families withand their in pain issues complex pain management. their Communicates with patients, effectively IDT and families, managers. Independently delivers and IDT nursing and/or education programmes. Communicates complex complex Communicates information effectively families, with patients, IDT and managers. on Collaborates the and initiate ofdevelopment policies guiding practice. Independently delivers and IDT nursing and/or education programmes at local, regional and national level. Elements ofElements care nursing Undertakes a Undertakes comprehensive biopsychosocial ofassessment a patient pain. with complex the effect Evaluates of pain management using approaches, biopsychosocial patients for assessments evidence-based receiving treatment. expert Undertakes biopsychosocial ofassessment a patient pain. with complex to solve/refer Problem of members other the IDT. the effect Evaluates of pain management using approaches, biopsychosocial patients for assessments evidence based receiving treatment. the effect Evaluates of self-management approaches. solve/ Problem changes recommend evidence). (based on Nursing responsibilities Nursing Demonstrates clinical clinical Demonstrates on decision-making the implementation and effect of pain strategies. management adverse Manages effects and completes comprehensive in documentation records. clinical Independently, and safely effectively allmanages aspects of for care biopsychosocial withthe patient (living pain. with) complex an Demonstrates expert of level clinical on decision-making ofthe effectiveness the pain biopsychosocial strategies. management interprets Independently the clinical and manages signs and symptoms withassociated multiple in a co-morbidities (or patient with complex living with) pain. competing Manages adverse demands, effects and completes comprehensive in documentation records. clinical I
Understanding pain Understanding Proficient Proficient Level 6 Level of practice Expert 7 and 8 Levels Footnotes 1 and neuromodulation. radiofrequency injection, neuraxial anaesthesia and regional and analgesia, infusions, subcutaneous/intravenous analgesia, patient controlled to not limited but ncluding
47 RCN Pain Knowledge and Skills Framework for the Nursing Team
References
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Benner P (1984) From novice to expert: Excellence and power in clinical nursing practice. Menlo Park, CA, Addison-Wesley
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IASP (2012) IASP Taxonomy, Updated from H. Merskey and N. Bogduk (1994) Part III: Pain Terms, A Current List with Definitions and Notes on Usage (pp 209-214) Classification of Chronic Pain, Second Edition, IASP Task Force on Taxonomy, Seattle, IASP Press [Accessed 17.08.2015]
McCaffery, M. (1968) Nursing Practice Theories Related to Cognition, Bodily Pain, and Man-Environment Interactions. Los Angeles: University of California.
New Zealand Pain Society Nurses’ Interest Group (2013) New Zealand Pain Management Nursing Knowledge and Skills Framework for Registered Nurses. Available from www.nzps.org.nz [Accessed 17.08.2015]
Pasero C, McCaffery M. (1999) Pain: clinical manual. St. Louis: Mosby.
Royal College of Nursing (2014) Knowledge and innovation plan for 2014-2018. London, RCN
Skills for Health (2010) Key elements of the career framework. Available from www.skillsforhealth.org.uk/resources/guidance-documents [Accessed 17.08.2015]
48 RCN Pain Knowledge and Skills Framework for the Nursing Team
Notes
49 RCN Pain Knowledge and Skills Framework for the Nursing Team
Notes
50 RCN Pain Knowledge and Skills Framework for the Nursing Team
Notes
51 September 2015 Review date September 2018 Supported by an educational grant from Grünenthal Ltd UK. Published by the Royal College of Nursing 20 Cavendish Square London W1G 0RN 020 7409 3333 www.rcn.org.uk
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