1 Children s nursing: Field specific competencies Page 8
2 Children's nursing: Field specific competencies Competency (Children's Nurses) and application Domain Suitable items for Multi-choice Exam: Nursing Suitable items for testing within OSCE's E* 1.1 Children s nurses must understand the laws relating to child and parental consent, including giving and refusing consent, withdrawal of treatment and legal capacity. D1 Professional values Competency 1 Consent Articulates the underpinning values of the code (NMC, 2015). Care, Compassion and Communication CCC1,1. Adopts a principled approach to care underpinned by the code (NMC, 2015) CCC4,3. Upholds peoples legal rights and speaks out when these are at risk of being compromised CCC4,4. Is acceptant of differing cultural traditions, beliefs, UK legal frameworks and professional ethics when planning care with people and their families and their carers CCC4,5. Through reflection and evaluation demonstrates commitment to personal and professional development and lifelong learning CCC5,13.
3 Acts professionally and autonomously in situations where there may be limits to confidentiality, for example, public interest and protection from harm CCC7,5. Works within legal frameworks for data protection including access to and storage of records CCC7,8. Works within legal frameworks when seeking consent CCC8, 5. Assesses and responds to the needs and wishes of carers and relatives in relation to information and consent. CCC8,6 Shares information safely with colleagues and across agency boundaries for the protection of individuals and the public. OAC11, 6. Works within ethical and legal frameworks and local policies to deal with complaints and concerns. OAC12,9. Challenges the practice of self and others across the multi-professional team OAC 14, 7 Works within the requirements of the code (NMC, 2015) in delegating care and when care is delegated to them. OAC15, 2.
4 Recognises and addresses deficits in knowledge and skill in self and others and takes appropriate action OAC15,5. Takes decisions and is able to answer for these decisions when required OAC 16,2 Appropriately reports concerns regarding staffing and skill-mix and acts to resolve issues that may impact on the safety of service users within local policy frameworks OAC 17,9. Works within legal and ethical frameworks that support promoting safety and positive risk taking. OAC18, 13. Applies research based evidence to practice OAC 9,14 Works within the limitations of the role and recognises own level of comptence.ccc1, 2 Applies legislation that relates to the management of specific infection risk at a local and national level. Infection Preventions and Control (IPC), 22,8. Assists people to make safe and informed choices about their medicines. MM.40,5.
5 Applies legislation to practice in safe and effective ordering, receiving, storing, administering and disposal of drugs, including controlled drugs in both primary and secondary care settings and ensures others do the same Medicine Management (MM), 34,4. Assesses the person s ability to safely self-administer their medicines.mm 40,4 Gives clear instructions and explanation and checks that a person understands the use of medicines and treatment options MM40,3. Fully understands all methods of supplying medicines, for example Medicines Act exemptions, patient group directions(pgds), clinical management plans and other forms of prescribing MM,34,6 2.1 Children s nurses must recognise that all children and young people have the right to be safe, enjoy life and reach their potential. They must practise in a way that recognises, respects and responds to the individuality of every child and young person. D1 Professional values Competency 2 Responds to the individuality of each child and young person Is sensitive and empowers people to meet their own needs and make choices and considers with the person and their carer(s) their capability to care. CCC2, 8. Ensures access to independent advocacy. CCC2, 9.
6 Acts autonomously and proactively in promoting care environments that are culturally sensitive and free from discrimination, harassment and exploitation. CCC,4,6 Makes effective referrals to safeguard and protect children and adults requiring support and protection. OAC11,7. Supports people in asserting their human rights. OAC11,9 Challenges practices which do not safeguard those in need of support and protection. OAC11, Children s nurses must act as advocates for the right of all children and young people to lead full and independent lives. D1 Professional values Competency 3 Advocacy for children and young people Acts with dignity and respect to ensure that people who are unable to meet their activities of living have choices about how these are met and feel empowered to do as much as possible for themselves. CCC2,12 Is proactive in promoting and maintaining dignity. CCC3,5.
7 Acts autonomously to challenges situations or others when someone's dignity may be compromised. CCC3,6 Works within the context of a multi-professional team and works collaboratively with other agencies when needed to enhance the care of people, communities and populations. OAC9,15. Promotes health and well-being, self care and independence by teaching and empowering people and carers to make choices in coping with the effects of treatment and the ongoing nature and likely consequences of a condition including death and dying. OAC 9,16 Discusses sensitive issues in relation to public health and provide appropriate advice and guidance to individuals, communities and populations for example, contraception, substance misuse, smoking, obesity. OAC9,18 Works within a public health framework to assess needs and plan care for individuals, communities and populations. OAC9,22. Is sensitive and empowers people to meet their own needs and make choices and considers with the person and their carer(s) their capability to care. CCC2,8. Ensures access to independent advocacy. CCC2, Children s nurses must work in partnership with children, young people and their families to negotiate, plan and deliver child and family-centred care, education and support. They must recognise the parent s or carer s primary role in achieving and maintaining the child s or young person s health and wellbeing, and offer advice and support on parenting in health and illness. D1 Professional values Competency4
8 Education and support for children, young people and their parents or carers Actively helps people to identify and use their strengths to achieves their goals and aspirations. CCC2,14 Uses appropriate strategies to empower and support their choice. CCC3,7. Recognises situations and acts appropriately when a person's choice may compromise their safety or the safety of others. CCC2,10. Uses strategies to manage situations where a person's wishes conflict with nursing interventions necessary for the person's safety. CCC2,11 Works autonomously, confidently and in partnership with people, their families and carers to actively empower people to be involved in their care planning and delivery including strategies for self care and peer support. CCC2,13. Acts appropriately in sharing information to enable and enhance care (carers, MDT and across agency boundaries). CCC7,7. Assesses and implements measures to manage, reduce or remove risk that could be detrimental to people, self and others. OAC18,11.
9 Works within legal and ethical frameworks to promote safety and positive risk taking. OAC18,13. Takes steps not to cross professional boundaries and put self or colleagues at risk. OAC18,15. Explains risks to people, relatives, carers and colleagues and educates them in prevention and control of infection. IPC21,10. Adheres to infection prevention and control policies and procedures at all times and ensures that colleagues work according to good practice guidelines. IPC22,9. Acts as a role model to others and ensure colleagues work within local policy IPC24,4 Able to communicate potential risks to others and advise people on their device, site or wound to prevent and control infection and to promote healing. IPC25, Children s nurses must work with the child, young person and others to ensure that they are actively involved in decision-making, in order to maintain their independence and take account of their ongoing intellectual, physical and emotional needs. D2 Communication and interpersonal skills Competency 1 Ensure the child or young person is actively involved in decision- making, and maintains their independence
10 Has insight into own values and how these may impact on interaction with others. CCC5,10. Works with people and carers to provide clear and accurate information MM40,2. Recognises and acts to overcome barriers in developing effective relationships with service uses and carers. CCC1,12. Acts autonomously to reduce and challenge barriers to effective communication and understanding. CCC6, Children s nurses must understand all aspects of development from infancy to young adulthood, and identify each child or young person s developmental stage, in order to communicate effectively with them. They must use play, distraction and communication tools appropriate to the child s or young person s stage of development, including for those with sensory or cognitive impairment. D2 Communication and interpersonal skills Competency 2 Child development, play, distraction techniques, sensory and cognitive impairment Engages with people in the planning and provision of care which recognises the importance of personal needs and providing both practical and emotional support. CCC5,9. Listens to, watches for and responds to verbal and non verbal cues. CCC5,8.
11 Uses skills of active listening, questioning, paraphrasing and reflection to support therapeutic intervention. CCC6, Children s nurses must ensure that, where possible, children and young people understand their healthcare needs and can make or contribute to informed choices about all aspects of their care. D2 Communication and interpersonal skills Competency 3 Informed choice Communicates effectively and sensitively in different settings, using a range of methods and skills CCC6, 8. Consistently shows ability to communicate safely and effectively with people providing guidance for others. CCC6,7 Provides accurate and comprehensive written and verbal reports based on sound evidence. CCC6, 9. Provides information to people and their carers. NFM.28,7. y Uses strategies to enhance communication and remove barriers to effective communication minimising the risk to people from lack of or poor communication. CCC6, 6.
12 1.1 Children s nurses must be able to recognise and respond to the essential needs of all people who come into their care including babies, pregnant and postnatal women, adults, people with mental health problems, people with physical disabilities, people with learning disabilities, and people with long term problems such as cognitive impairment. D3 Nursing practice and decision making Competency 1 Respond to the needs of pregnant and postnatal women Respond to the needs of adults Respond to the needs of people with mental health problems Respond to the needs of people with physical disabilities Respond to the needs of people with learning disabilities Respond to the needs of people with dementia Demonstrates clinical confidence through sound knowledge, skills and understanding relevant to field. CCC1,8.
13 Recognises the significance of information and acts in relation to who does or does not need to know. CCC,7,6 Refers to specialists when required. OAC9,19 Works within the code (NMC, 2015) and in keeping with guidance on professional conduct for nursing and midwifery students (NMC,2010) and in collaboration with people and their carer's to meet responsibilities for prevention and control of infection. IPC.21,7. Recognises and acts upon the need to refer to specialist advisors as appropriate. IPC23,5. Refers to specialist members of the multi- disciplinary team for additional or specialist advice. NFM27,8. Acts appropriately in sharing information to enable and enhance care with carers, multi-disciplinary teams and across agency boundaries. CCC7, Children s nurses must use recognised, evidence-based, child-centred frameworks to assess, plan, implement, evaluate and record care, and to underpin clinical judgments and decisionmaking. Care planning and delivery must be informed by knowledge of pharmacology, anatomy and physiology, pathology, psychology and sociology, from infancy to young adulthood. D3 Nursing practice and decision making Competency 1 Evidence based, child-centred framework for planning care
14 Clinical judgement and decision making Pharmacology Anatomy and physiology Pathology Psychology and sociology Demonstrates clinical confidence through sound knowledge, skills and understanding relevant to field. CCC1,8. Recognises the significance of information and acts in relation to who does or does not need to know. CCC,7,6 Refers to specialists when required. OAC9,19
15 Works within the code (NMC, 2015) and in keeping with guidance on professional conduct for nursing and midwifery students (NMC,2010) and in collaboration with people and their carer's to meet responsibilities for prevention and control of infection. IPC21,7. Recognises and acts upon the need to refer to specialist advisors as appropriate. IPC23,5. Refers to specialist members of the multi- disciplinary team for additional or specialist advice. NFM27,8. Acts appropriately in sharing information to enable and enhance care with carers, multi-disciplinary teams and across agency boundaries. CCC7, Children s nurses must carry out comprehensive nursing assessments of children and young people, recognising the particular vulnerability of infants and young children to rapid physiological deterioration. D3 Nursing practice and decision making Competency 3 Recognise and act on rapid physiological deterioration Actively empowers people to be involved in the assessment and care planning process. CCC2,2. Accurately undertakes and records base line assessments of weight, height, temperature, pulse, respiration and blood pressure using manual and electronic devices. OAC9,2
16 Takes and records accurate measurements of weight, height, length, body mass index and other appropriate measures of nutritional status. NFM28,1 Measures documents and interprets vital signs and acts autonomously and appropriately on findings OAC 9,21 Acts autonomously and appropriately when faced with sudden deterioration in people's physical or psychological condition or emergency situation, abnormal vital signs, collapse, cardiac arrest, dehydration, self harm, extremely challenging behaviour, attempted suicide. OAC9,20. Performs routine diagnostic tests, for example urinalysis, under supervision as part of the assessment process (near client testing). OAC9,7. In partnership with the person, their carers and their families, makes a holistic, person centred and systematic assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk, and together, develops a comprehensive personalised plan of nursing care. OAC9,12. Acts autonomously and takes responsibility for collaborative assessment and planning of care delivery with the person, their cares and their family. OAC9,13. Provides accurate and comprehensive written reports based on best possible evidence. CCC6,9. Works within a public health framework when assessing the needs of people, communities and populations within the UK. OAC9,22.
17 5.1 Children s nurses must include health promotion, and illness and injury prevention, in their nursing practice. They must promote early intervention to address the links between early life adversity and adult ill health, and the risks to the current and future physical, mental, emotional and sexual health of children and young people. D3 Nursing practice and decision making Competency 5 Health promotion Risk assessment Physical, mental, emotional and sexual health Acts autonomously and proactively in promoting care environments that are culturally sensitive and free from discrimination, harassment and exploitation. CCC4,6. Recognise infection risk and reports and acts in situations where there is need for health promotion and protection and public health strategies IPC.21,11. Understands the concept of public health and the benefits of healthy lifestyles and the potential risks involved with various lifestyles or behaviours, for example, substance misuse, smoking, obesity. OAC,9,3 Works within a public health framework to assess needs and plan care for individuals, communities and populations. OAC9, 22.
18 Supports people in asserting their human rights. OAC11, Children s nurses must have numeracy skills for medicines management, assessment, measuring, monitoring and recording which recognise the particular vulnerability of infants and young children in relation accurate medicines calculation. D3 Nursing practice and decision making Competency 6 and associated ESCs Application of Number Medicines management Safely uses and maintains a range of medical devices appropriate to the area of work, including ensuring regular servicing, maintenance and calibration including reporting adverse incidents relating to medical devices. OAC20,3 Works within legal frameworks and applies evidence based practice in the safe selection and use of medical devices. OAC20,2 Administers enteral feeds safely and maintains equipment in accordance with local policy. NFM31,4. Safely, maintains and uses naso-gastric, PEG and other feeding devices. NFM31,5
19 Monitors infusion sites for signs of abnormality and takes the required action reporting and documenting signs and actions taken NFM32,4. Understands and applies knowledge of intravenous fluids and how they are prescribed and administered within local administration of medicines policy. FM32,1 Safely performs wound care, applying non-touch or aseptic techniques in a variety of settings. IPC25,4. Manages hazardous waste and spillages in accordance with local health and safety policies. IPC26,4. Instruct others to do the same IPC.26,5. Adheres to health and safety at work legislation and infection control policies regarding the safe disposal of all waste, soiled linen, blood and other body fluids and disposing of sharps including in the home setting. IPC26,1 Is competent in the process of medication-related calculation in nursing field involving: tablets and capsules, liquid, injections and IV infusions including; unit dose, sub and multiple doses, complex calculations and SI units, for all ages. MM33,2. Safely manages drug administration and monitors effects MM36,4.
20 Safely and effectively administers and, where necessary, prepares medicines via routes and methods commonly used and maintains accurate records. MM38,4. Supervises and teaches others to do the same. MM38,5, Understands the legal requirements MM38,6 Orders, receives, stores and disposes of medicines safely (including controlled drugs) MM37,2. Demonstrates knowledge of what a patient group directive is and who can use them. MM 42,1 Understands all methods of supplying medicines, for example, Medicines Act exemptions, patient group directions, clinical management plans and other forms of prescribing. MM34,5 Through simulation and coursework demonstrates knowledge and application of principles required for safe and effective supply and administration via a patient group direction including an understanding of role and accountability. MM42,2 Demonstrates awareness of a range of commonly recognised approaches to managing symptoms, for example, relaxation, distraction and lifestyle advice. MM35,7
21 Through simulation and course work demonstrates how to supply and administer via a patient group direction. MM42,3. Fully understands the different types of prescribing including supplementary prescribing, community practitioner nurse prescribing, and independent nurse prescribing MM34,6 Accesses commonly used evidence based sources relating to the safe and effective management of medicine. MM40,1 8.1 Children s nurses must use negotiation skills to ensure the best interests of children and young people in all decisions, including the continuation or withdrawal of care. Negotiation must include the child or young person, their family and members of the multidisciplinary and interagency team where appropriate. D3 Nursing practice and decision making Competency 8 Negotiation skills Withdrawal of care Is sensitive and empowers people to meet their own needs and make choices and considers with the person and their carer(s) their capability to care. CCC,2,8 Acts with dignity and respect to ensure that people who are unable to meet their activities of living have choices about how these are met and feel empowered to do as much as possible for themselves. CCC2,12.
22 Actively helps people to identify and use their strengths to achieve their goals and aspirations. CCC2,14 Uses helpful and therapeutic strategies to enable people to understand treatments and other interventions in order to give informed consent. CCC,8,4 Demonstrates respect for the autonomy and rights of people to withhold consent in relation to treatment within legal frameworks and in relation to people's safety. CCC,8,7 Assess the person's ability to safely self-administer their medicines MM40,4. Supports people to make appropriate the choices and changes to eating patterns, taking account of dietary preferences, religious and cultural requirements, treatments and special diets needed for health reasons. NFM.27,7. Promotes health and well-being, self care and independence by teaching and empowering people and carers to make choices in coping with the effects of treatment and the ongoing nature and likely consequences of a condition including death and dying. OAC9, Children s nurses must understand their central role in preventing maltreatment, and safeguarding children and young people. They must work closely with relevant agencies and professionals, and know when and how to identify and refer those at risk or experiencing harm. D3 Nursing practice and decision making Competency 9 Safeguarding children
23 Referral to other agencies Recognises and responds when people are in vulnerable situations and at risk, or in need of support and protection. OAC11,5 Makes effective referrals to safeguard and protect children and adults requiring support and protection. OAC11,7 Works collaboratively with other agencies to develop, implement and monitor strategies to safeguard and protect individuals and groups who are in vulnerable situations. OAC11,8 Supports people in asserting their human rights. OAC11,9 Challenges practises which do not safeguard those in need of support and protection. OAC11,10 Recognises stress in others and provides appropriate support or guidance ensuring safety to people at all times. OAC17,10. Selects and applies appropriate strategies and techniques for conflict resolution, de-escalation and physical intervention in the management of potential violence and aggression. OAC 19,3.
24 1.1 Children s nurses must understand health and social care policies relating to the health and wellbeing of children and young people. They must, where possible, empower and enable children, young people, parents and carers to influence the quality of care and develop future policies and strategies. D4 Leadership, management and team working Competency 1 Health and social policies Empowering children, young people, parents and carers to influence change Responds appropriately when people want to complain, providing assistance and support. OAC12,2 Shares complaints, compliments and comments with the team in order to improve care. OAC 12,5. As an individual team member and team leader, actively seeks and learns from feedback to enhance care and own and others professional development. OAC 12,8 Actively consults and explores solutions and ideas with others to enhance care. OAC14,6. Challenges the practice of self and others across the multi-professional team. OAC14,7
25 Appropriately reports concerns regarding staffing and skill mix and acts to resolve issues that may impact on the safety of service users. OAC17,9 Reflects on and learns from safety incidents as an individual and as a team member and contributes to team learning. OAC18,9 Challenges others who do not follow procedures. NFM30,5. Participates in clinical audit to improve the safety of service users. OAC18, Children s nurses must ensure that, wherever possible, care is delivered in the child or young person s home, or in another environment that suits their age, needs and preferences. Home nursing Nursing in other environments Responds appropriately when people want to complain, providing assistance and support. OAC 12,2
26 Shares complaints, compliments and comments with the team in order to improve care. OAC 12,5. As an individual team member and team leader, actively seeks and learns from feedback to enhance care and own and others professional development. OAC 12,8 Actively consults and explores solutions and ideas with others to enhance care. OAC14,6. Challenges the practice of self and others across the multi-professional team. OAC14,7 Appropriately reports concerns regarding staffing and skill mix and acts to resolve issues that may impact on the safety of service users. OAC17,9 Reflects on and learns from safety incidents as an individual and as a team member and contributes to team learning. OAC18,9 Challenges others who do not follow procedures. NFM30,5. Participates in clinical audit to improve the safety of service users. OAC18,10
27 6.1 Children s nurses must use effective clinical decision-making skills when managing complex and unpredictable situations, especially where the views of children or young people and their parents and carers differ. They must recognise when to seek extra help or advice to manage the situation safely D4 Leadership, management and team working Competency 6 Complex care Unpredictable situations Seeking extra help and advice Works autonomously, confidently and in partnership with people, their families and carers to ensure that needs are met through care planning and delivery, including strategies for self care and peer support. CCC2,13. Acts as a role model in developing trusting relationships, within professional boundaries. CCC1,11 Actively consults and explores solutions and ideas with others to enhance care. OAC14,6. Works inter-professionally and autonomously as a means of achieving optimum outcomes for people. OAC14,10.
28 Safeguards the safety of self and others, and adheres to lone working policies when working in the community setting and in people s homes. OAC14,11. Works within local policies when working in the community setting including people's homes and ensures the safety of others. OAC17,12 Identifies suitable alternatives when isolation facilities are unavailable and principles have to be applied in unplanned circumstances. IPC23,8. Ensures that people including colleagues are aware of and adhere to local policies in relating to isolation and infection control procedures. IPC,23,7 Works within national and local policies and ensures others do the same. MM40,2 Works confidently as part of the team and, where relevant, as leader of the team to develop treatment options and choices with the person receiving care and their carers. MM.35,9 Works within the requirements of the code (NMC, 2015) in delegating care and when care is delegated to them. OAC15, Children s nurses must work effectively with young people who have continuing health needs, their families, the multidisciplinary team and other agencies to manage smooth and effective transition from children s services to adult services, taking account of individual needs and preferences. D4 Leadership, management and team working Competency 7
29 Continuing health needs Managing transition of care Assists in preparing people and carers for transfer and transition through effective dialogue and accurate information. OAC13,1. Reports issues and people's concerns regarding transfer and transition. OAC13,2. Assists in the preparation of records and reports to facilitate safe and effective transfer. OAC13,3.
30 Online Resources Below are some useful online links which can be used to support preparation for the NMC's Test of Competence (A - Z). These online links are not exhaustive, and many other useful sources will exist. The links are designed to help candidates identify gaps as they explore each domain and competence. Candidates should consider the need for revision and consolidation of knowledge before taking the test of competence. Please copy and paste the links into your web browser to access the information data/assets/pdf_file/0003/78573/ pdf
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