Cardiac Nursing - Acute/Episodic Care Career Pathway
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Cardiac Nursing - Acute/Episodic Care Career Pathway Competency Statements Cardiac Nursing Competency Statements January 2004 (Blank) 1 Foreword by Professor David Thompson In an era of the so-called ‘knowledge economy’, the concept of ‘lifelong learning’ and the belief that ‘education matters’, there is a need to ensure that skills (be they basic, core or key) as well as knowledge are developed. Indeed, Skills for Health, a government-backed body which has the support of the four UK health departments, the independent health sector, voluntary sector and staff organisations, has as its key aim the development of skills for all those people employed by the NHS or in the independent health sector. One of the key building blocks for Skills for Health is the use of ‘competency frameworks’. These frameworks identify the skills, experience and training which will help ensure consistency and quality across healthcare in the UK. The frameworks comprise a set of statements identifying what people or teams need to know and be able to do to deliver that service. These Cardiac Nursing – Acute/Episodic Care Career Pathway: Competency Statements, developed by the British Association for Nursing in Cardiac Care (BANCC) in collaboration with the Royal Brompton and Harefield NHS Trust and Thames Valley University, are an important contribution to nursing and work in conjunction with the Skills for Health competency framework being developed for prevention, heart failure and rehabilitation in coronary heart disease. Well-defined competencies from entry to practice through to advanced practice are needed in nursing, and they need to be refined to ensure greater accountability to patients and clients and their families and carers, within the profession, in relation to other health professionals, and with regard to the various contexts of practice. These Cardiac Nursing – Acute/Episodic Care Career Pathway: Competency Statements should certainly fulfil their purpose of guiding the career development of nurses across acute cardiac care settings. They should also help produce cardiac nurses who are ‘fit for purpose’, in that they are knowledgeable, clinically competent, thoughtful, critical and articulate. Professor David R Thompson BSc MA PhD MBA RN FRCN FESC January 2004 Cardiac Nursing Competency Statements 2 January 2004 (Blank) 3 Contents Introduction................................................................................................................. 6 Explanation of Competency Statements..................................................................... 7 Definition of competence ...................................................................................... 7 Scope of the competency topics........................................................................... 7 Competency sections ........................................................................................... 7 Competency development stages ........................................................................ 8 Assessment of competence.................................................................................. 8 Evidence utilised............................................................................................. 8 Peer review/assessors.................................................................................... 9 Maintenance of competence........................................................................... 9 Example of use of the cardiac nursing competency pathway ............................... 9 Acknowledgements............................................................................................... 9 References ......................................................................................................... 11 Record of Peer reviewers/Assessors........................................................................ 12 Example of use of the cardiac nursing competency document................................. 13 Competency sections ............................................................................................... 15 Core Professional Competencies ....................................................................... 15 Respecting and promoting individuality ........................................................ 15 Communication – patients ............................................................................ 17 Communication - multidisciplinary team ....................................................... 19 Education - patients ...................................................................................... 21 Education – staff........................................................................................... 23 Leadership.................................................................................................... 25 Managing resources ..................................................................................... 27 Standards and protocols............................................................................... 29 Research ...................................................................................................... 31 Core Clinical Competencies ............................................................................... 33 Haemodynamic monitoring ........................................................................... 33 ECG monitoring and interpretation ............................................................... 35 Arterial oxygenation management ................................................................ 37 Delivery of oxygen therapy – non-invasive ................................................... 39 Auscultation of heart sounds......................................................................... 41 Auscultation of breath sounds....................................................................... 43 Blood sampling and cannulation................................................................... 45 Blood sample analysis .................................................................................. 47 Chest x-ray interpretation.............................................................................. 49 Underwater seal chest drains ....................................................................... 51 Wound healing.............................................................................................. 53 Assessment of cardiac chest pain ................................................................ 55 Specialised Clinical Competencies..................................................................... 57 Delivery of oxygen therapy – supportive....................................................... 57 Resuscitation/ life support............................................................................. 59 Femoral arterial sheath removal ................................................................... 61 Cardiac pacing – temporary.......................................................................... 63 Cardiac pacing – permanent......................................................................... 65 Cardiac Nursing Competency Statements 4 January 2004 Intra-aortic counterpulsation ......................................................................... 67 Elective cardioversion................................................................................... 69 Thrombolysis – nurse-initiated...................................................................... 71 Exercise tolerance testing............................................................................. 73 Tilt-table testing ............................................................................................ 75 Appendix 1................................................................................................................ 78 Feedback / comments on Cardiac Nursing – Acute/Episodic Care Competency Statements ............................................................................................................... 80 5 Introduction The evolution of this career pathway has arisen from the desire to improve patient outcome through assuring a high quality cardiac nursing service delivery. The pathway, as illustrated in Figure 1, suggests that a balance between education, training and practice can be achieved in a way that will advance career progression. Driven by current professional, political and societal forces, this is in keeping with the current strategic intentions for nursing outlined by the Department of Health in the paper “Making a Difference” (Department of Health, 1999) and the Chief Nursing Officer’s key roles for nurses (The Stationery Office, 2001). Figure 1. Career development pathway of the cardiac nurse Advanced clinical development Higher degree/ Masters/PhD Intermediate clinical development Specialist study/post-graduate diploma Immediate post-registration clinical development Initial diploma/degree Pre-registration clinical development Preparation for initial diploma/degree Cardiac nursing takes place within various spheres of health care: primary, secondary and tertiary care. Within these, cardiac nursing expertise tends to fall into four domains: health promotion, cardiac prevention and rehabilitation, acute/chronic and episodic care, and palliative care (Riley, Bullock, West & Shuldham, 2003). The focus of this document is to present cardiac nursing competency statements for acute/episodic care that utilises the pathway described above. Appropriate settings for the use of these