Central & Eastern Cheshire End of Life Care Competency Framework

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1 Central & Eastern Cheshire End of Life Care Competency Framework Registered Nurses (St. Christopher s Level 2) Name:.. Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 1

2 Registered Nurses/ Registered Practitioners Indicators (St Christopher s Level 2) Appraisal Document Agreed at Appraisal (date & signature of student & appraisor) Knowledge The registered nurse/ practitioner will increase their knowledge, understanding and application of: The therapeutic nature of the nurse/ patient relationship at the end of life The internal and external coping strategies and emotions experienced by patients and carers when facing dying and death, eg: fear, anger, denial and collusion. The principles and rationale for involving patients and families in advance care planning The procedure for referring patients and carers to other professionals and agencies, and how to obtain equipment. The importance of confidentiality, knowing when it is appropriate to disclose information to staff, patients and carers The principles of mentorship and reflective practice to facilitate learning and practice development. The research base which underpins effective end of life nursing care. The principles and practice of palliative nursing care, including the principles of management of commonly experienced symptoms at the end of life Anatomy, physiology and pathology and how these apply to end of life, particularly including nutrition and hydration. The implications of co-morbidity, e.g. heart disease, diabetes, renal failure. Legal and ethical issues related to end of life care, e.g. informed choice, valid consent and mental capacity. The effect of bereavement on relatives and carers mental and physical health and the need to respond to this professionally. The principles and underpinning rationale for end of life tool use eg: Liverpool Care Pathway, Gold Standards Framework and Advance Care Planning. What welfare benefits patients and their carers may be entitled to at the end of life and how to access them. The policies around medicines management at end of life and methods of drug administration, e.g. subcutaneous administration via a syringe driver. Attitudes The registered nurse/ practitioner will improve their ability to: Recognize their professional duty of care to ensure that patients/ families have been given and have understood all the information they require to make informed end of life decisions. Recognize that exposure to and experience of working with dying patients and their families demands a level of confidence and skill in communication regarding end of life issues. Recognize that personal experiences of death and dying, stress and bias may affect their own capacity to listen and respond appropriately. Create an environment where patients and carers feel supported and empowered to communicate their needs/ feelings. Consider care and compassion to be core values of nursing. Respect autonomy and the right of the patient to refuse care. Respect cultural and religious difference regarding end of life beliefs and practices. Recognize professional responsibility to promote own and colleagues learning and development in end of life care skills as per NMC code (2008). Recognize own limitations and refer to other professionals as appropriate. Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 2

3 Registered Nurses/ Registered Practitioners Appraisee Work Book This work book is intended to give the appraisee guidance on what evidence they should prepare for their appraisal to demonstrate achievement of the end of life care competencies. This work book can also be used and signed off during clinical placements or following attendance at relevant learning and development events. The Management and Quality dimensions in St Christopher s documentation are integrated into the core dimensions of Communication, Education and Clinical Practice. Communication Level 2 NHS KSF: C1; IK 1 Examples/ Evidence/ Discussions achieved/ Signatures 1. Evidence from clinical practice that reflects use of empathy, sensitivity & compassion. Patient notes, personal reflections, case studies, team meeting reflections on practice 2. Evidence from clinical practice that facilitates patients and families expressing their individual needs irrespective of background or communication difficulties. 3. Evidence of recognising the negative emotions around death and dying which may affect both the patient and the practitioner s ability to communicate effectively. 4. Evidence of best practice in the use of end of life documentation for e.g. Preferred priorities for Care, Liverpool Care Pathway, Advance Care Planning. 5. Evidence of functioning as an effective member of the multidisciplinary team to enable partnership working and to promote effective communication skills. 6. Evidence that reflects best practice in communication throughout the patient journey e.g. from diagnosis through to bereavement and beyond. Patient notes, personal reflections, case studies, team meeting reflections on practice, particularly for patients/ families from hard to reach groups, or with communication problems such as hearing, language Patient notes, personal reflections, case studies, palliative care course materials or assignments Anonymised photocopies of case notes and reflections on MDT notes, your contributions, s or telephone calls which encourage good communication re: patients across care settings Cross boundary communication throughout patient journey, bereavement visit reflections, 7. Evidence that reflects knowledge of policy on Do Not Attempt Resuscitation and Advance Decisions to Refuse Treatment, and appropriate communication with patients and carers around these subjects, with referral onto other colleagues as necessary. Patient notes, referral forms to OOH and other teams, reflection on discussions Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 3

4 Education & Training Level 2 NHS KSF: C2; G1 Examples/ Evidence/ Discussions achieved/ Signatures 1. Evidence of effective reflection in order to ensure continuous professional development in end of life skills for self and others. Team meetings, GSF meeting discussions and After Death Analyses, personal reflections on learning, identification of and attendance at relevant training 2. Evidence of being a role model in high quality essential care of dying patients for carers and colleagues. Peer review documents, managers comments, s 3. Evidence of effectively teaching junior staff to manage and develop confidence in ensuring comfort at end of life. Reflection on your mentoring of staff, joint visit patient notes, team meetings Clinical Practice Level 2 NHS KSF: HWB 2, 3, 4, 5, 6, 7; C 3, C 6 Examples/ Evidence/ Discussions achieved/ Signatures 1. Evidence of holistic assessment for patients and their carers with palliative care needs. Anonymised photocopies of holistic assessments, reflections 2. Evidence of confidence and competence in commencing the Integrated Care Pathway for patients and communicating appropriately about this. 3. Evidence of care that meets the patients and their carers complex and changing needs. 4. Evidence of the practitioner working in patients best interests in line with organisational policies and procedures e.g. manual handling, ordering of and safe use of equipment, prevention of falls, risk management, infection control. Anonymised discussions with GPs, family, patients and colleagues about commencement of the ICP Patient notes, care plans, action plans, GSF meeting planning, record of communications about patients changing needs across disciplines, referral forms Equipment ordered, risk assessments, evidence of measures taken for patient safety 5. Evidence of involvement of multidisciplinary team to deliver high quality end of life care. MDT notes, your contributions, s or telephone calls which encourage good communication re: patients across care settings, rapid discharges 6. Evidence of best practice in administration of medicines. Patient notes, evidence of liaison with GPs around patient medications, patient assessments to do with medications Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 4

5 End of Life Care Action Plan END OF LIFE COMPETENCY DIMENSION WHAT KNOWLEDGE AND SKILLS DO YOU WISH TO DEVELOP? HOW WILL YOU DEVELOP THIS NEW KNOWLEDGE / SKILL? TIME FRAME FOR REVIEW AND COMPLETION Communication NHS KSF: C1; IK 1 Education & Training NHS KSF: C2; G1 Clinical Practice NHS KSF: HWB 2, 3, 4, 5, 6, 7; C 3, C 6 Signed (Job holder) Signed (Reviewer) Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 5

6 Reflections Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 6

7 Office use only Rec. Input... Input By Organisation 209 East Cheshire NHS Trust End of Life Care Appraisal Please submit this form when you have completed an End of Life Care Appraisal. DO NOT use this form for any other type of appraisal. Complete this form electronically and to: OR post to Learning and Development Admin Team, Gladman House, Alexandria Way, Congleton Business Park, Congleton, Cheshire CW12 1LB Please indicate the level of appraisal that was completed: End of Life Care - Level 1 End of Life Care - Level 2 End of Life Care - Level 3 End of Life Care - Level 4 Employees Name Department Job title Reviewers Name Job title Department Telephone number V1 L&D Admin Team 27-Oct-2011 Formulated by Cheshire End of Life Care Model (2011), with acknowledgement to St. Christopher s End of Life Care Competencies (2009). 7

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