RCN competences · Ear, Nose and Throat (ENT) disorders are common adults and health professionals frequently encounter them. ENT disorders can vary from minor transient conditions

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RCN competences:an education and training framework for ear nose and throat nursingUpdate 2018

RCN COMPETENCES: AN EDUCATION AND TRAINING FRAMEWORK FOR EAR NOSE AND THROAT NURSING

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This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are advised that practices may vary in each country and outside the UK.

The information in this booklet has been compiled from professional sources, but its accuracy is not guaranteed. Whilst every effort has been made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it may be used. Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused directly or indirectly by what is contained in or left out of this website information and guidance.

Published by the Royal College of Nursing, 20 Cavendish Square, London, W1G 0RN

© 2018 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of binding or cover other than that in which it is published, without the prior consent of the Publishers.

AcknowledgementsSpecific thanks to the following: The Royal College of Nursing (RCN) would like to thank the following committee members of the RCN ENT/Maxillofacial Nursing Forum for their work in rewriting, revising and proof reading this document and the production of supporting evidence in keeping with current practice: Andrew Hill, ENT Advanced Nurse Practitioner, University Hospitals NHS Trust Bristol Angela Griggs, Quality and Safety Manager, The Royal National Throat, Nose and Ear Hospital, University College London Hospitals NHS Foundation Trust and Lecturer Practitioner ENT Nursing City University of London. Kathryn Markham, Advanced Nurse Practitioner ENT, University Hospitals Birmingham NHS Foundation Trust, Heartlands HospitalJudith Muir, Matron Head & Neck and Ophthalmology, Gloucestershire Hospitals NHS TrustMichelle Tait, Advanced Nurse Practitioner, North Cumbria University Hospitals, NHS Trust Cumberland Infirmary, Carlisle

We would also like to acknowledge the original forum committee and working group from 2012 for formulating the competences and how this integrates with potential training needsStaff within the RCN who helped get this document to publication. The ENT/Maxillofacial Nursing forum for the efforts and collaborative working. Finally to the ENT/Maxillofacial Nursing forum network which has provided informed comment that means the document is relevant to current clinical practice.

ROYAL COLLEGE OF NURSING

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1 Purpose and scope of this document 2

2 Ear Nose and Throat Nursing: clarification of roles 6

3 Ear Nose and Throat nursing competences: 7

Practice and service development 7

Teaching and education 9

4 Ear Nose and Throat nursing competences:

Specialist psychological/psychosocial/physical interventions 10

Counselling 10

Assessment, investigation and treatment 12

Lifestyle 16

Management of deterioration in pre-existing Ear Nose and Throat condition 17

Teaching self care skills 19

Specialist clinical interventions 20

5 Skills for Health Competences and references 21

6. Useful organisations and their websites 23

Contents


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1. Purpose and scope of this document Competence can be defined as: “The state of having the knowledge, judgement, skills, energy, experience and motivation required to respond adequately to the demands of one’s professional responsibilities” (Roach, 1992).

Since the release of this document in 2012 nurse education and clinical service provision has moved forward but equally has become increasingly divergent with minor differences in health care ideologies between the 4 countries of the UK. As NHS services modernise and have to find more effective ways of working many ENT and aural care services have become squeezed. It is therefore vital that such services have a robust framework of service provision, training, education as well as the maintenance of standards regardless of the grade of nurse providing that service.

With the advent of Revalidation (NMC 2016) our knowledge, skills, care and treatment provision are more formally considered. This crystallises and portrays the importance of what we do and that public safety is all our concern. The NMC standards for competence for registered nurses (2014) apply in all fields of nursing and are set out four main areas.

• Professional values

• Communication

• Nurse practice and decision making

• Leadership

Within these areas we are professionally obligated to demonstrate knowledge and competence; it is the aim of this document to endorse this position.

Advancing practice in our field leads to increasing autonomous practice and often working out of hours. It is therefore import to pathways of education, training and maintenance of competence not only for the place of work but to be truly interchangeable and recognised by other Trusts. This will ensure mobility within the workforce.

The RCN has endorsed the model of credentialing (2017) since 2012 and may go some

way to protecting titles and ensuring we have an interchangeable currency of nursing care provision beyond 2020.

Further changes have seen the encouragement toward the use of the simplified core dimensions of knowledge and skills framework (NHS employers 2017). This makes appraisals and evaluation of roles easier. Trusts can continue to use the full KSF framework (2004). This document will continue to focus on the core dimensions.

• Communication

• Personal and people development

• Health, safety and security

• Service improvement

• Quality

• Equality and diversity

Ear, Nose and Throat (ENT) disorders are common adults and health professionals frequently encounter them. ENT disorders can vary from minor transient conditions such as; tonsillitis, Otitis externa and epistaxis to the chronic seen in severe nasal polyposis, persistent ottorrhoea and functional losses following throat surgery. The goal for managing patients with these disorders is for them to live a life as free as possible from clinical and psychological complications. As healthcare professionals it is vital that we provide patients with the knowledge and tools to treat symptoms that often hinder daily life.

Many adults will be cared for in primary care, through out of hours services, walk-in clinics and GP surgeries. A significant number of patients will be cared for in secondary care either for ongoing management or access to specific equipment and skills. Health care professionals in both these settings must be able to demonstrate relevant knowledge, competence, skills and experience in ENT disorders.

Recognising this need, ENT nurses from across the UK have developed this RCN competency framework. The framework aims to establish explicit, nationally agreed role profiles for adult


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ENT specialist nursing roles, in order to:

Support practitioners in career planning and personal development.

Guide further role development and educational preparation inform future pay negotiations.

Support managers in workforce planning and in developing role requirements/job descriptions for specific posts.

Roaches (1992) original definition is further endorsed by Casey et al (2017) position of putting competency into practice.

“Competence incorporates knowledge, skills, attitudes, professionalism, application of evidence and translating learning into practice. It is specific to the nurse’s/midwife’s role, organizational needs, patient’s needs and the individual nurse’s/midwife’s learning needs. Competencies develop over time and change as nurses and midwives work in different practice areas. Thus, role-specific competence is linked to recent engagement in practice” (Casey et al 2017)

The Health Safety Executive for the UK (2017) also sees competence in terms of application

Competence can be described as: the combination of training, skills, experience and knowledge that a person has and their ability to apply them to perform a task safely. (HSE 2017)

What is a competence framework? A nurse is competent when she or he possesses the skills and abilities required for lawful, safe and effective professional practice without direct supervision. Competences can be thought of as underlying characteristics of individuals, which result in effective performance. They are described as a combination of knowledge, skills, motives and personal traits. Competence in this sense is generally seen in the way someone behaves. Standards for competence for registered nurses are now also comprehensively laid out by The NMC (2014) that endorses a career long approach to maintaining competency and skill sets.

A competence framework is a collection of competences that are thought to be central to effective performance. The aim of this

competence document is to draw upon core issues and principles central to develop and maintain high standards of practice as well as professional integrity in the ENT and aural care nursing specialty.

The role framework The RCN framework draws upon previous competence developments and role definitions and in particular, builds on generic nursing role and knowledge and skills framework. It is therefore important to note that The Nursing and Midwifery Council (NMC) The code: Professional standards of Practice and behaviour for nurses and midwives (2015) has public protection as its primary concern.

The role of the framework will allow the ENT and aural care nurse to provide a good foundation to base best possible practice using evidenced based approaches and provide a focus for the central process of keeping up to date. With the advent of revalidation and credentialing the framework can be used to shape formation of courses designed to meet the service need.

In addition, The Standards of Medicine Management (NMC 2007) make it clear the proficiency and standards needed for safe medicine management and specifically the relevant knowledge, competence, skills and experience in using patient group directives (PGDs) and patient specific direction (PSD). The framework now also takes into consideration the increasing role of advanced practice including the impact of image requesting

The NMC recognises that safe, effective and appropriate adult nursing involves more than just the application of theory to practice.

Core role descriptors and competences The primary sources for the core role descriptors and competences were the Agenda for change knowledge and Skills framework and skills for health competences. References to these are given in the tables below.

The use of this as a framework focuses on the core skills and competences to underpin the role as an ENT care provider. Other descriptors may need to be added or revised when considering your specific job and service provision need.


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Level 5 Competent nurse

Specialist ENT Nurse

Uses clinical judgement and individual decision-making in relation to the specialist nursing care and management of patients.

Undertakes a range of specialist clinical action without supervision or direction.

Level 6 Experienced nurse


Uses clinical judgement and autonomous decision-making in relation to the specialist nursing care and management of patients.

Undertakes a range of specialist clinical actions within a specific setting after assessing patient need and care.

Level 7 Senior Practitioner/Expert Nurse


Uses clinical judgement and autonomous decision-making in relation to the specialist nursing care and management of patients.

Undertakes a range of specialist clinical actions across a variety of settings after assessment of patient need and care.

2. ENT nursing: clarification of roles

When working at higher levels of practice (level 7) it is expected that the user meets all the lower criteria levels (5 and 6).


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Level Competence KSF Performance criteriaKnowledge and understanding

Attitudes and behaviours

Contextual factors

5 Promotes adherence to policy, standards and care delivery strategies related to the care and management of adults with ENT condition

Core 4 Level 2

Consistently adheres to all relevant policy, standards and care delivery strategies. Assertively challenges members of the care team where policies, standards and care delivery strategies are not adhered to. Raises concerns with senior members of the care team.

All related policies, standards and care delivery strategies used within own area of practice.

Assertive. Role modelling adherence to organisational policy, standards and care delivery strategies.

NICE guidelines in relation ENT conditionsNMC Record keeping guidance. NMC A-Z advice sheets Legislation relating to consent. Skills for Health Competences Local policies and guidelines

Implements andparticipates in the evaluation of innovations in the care of adults With ENTConditions

Documentation clearly shows accurate and authentic records of interventions undertaken related to the innovations in care. Provides accurate information to senior team members regarding the effects of treatment and progress made.

ENT treatment regimes applicable to Adults in their care.

6 Policy development. Standards development. Care delivery strategies. ENT treatment regimes and research applicable to nursing and adults with ENT conditions.

Core 4 Level 2

Policies and standards used within the clinical area are up to date and relevant to current practice.Minutes of meetings show clear record of constructivelyidentifying issues with policies/standards and care delivery strategies, along with constructive suggestions made to inform

Policy development. Standards development. Care delivery strategies. ENT treatment regimes and research applicable to nursing and adults with ENT conditions.

Ensures knowledge and practice iscurrent and reflects best practice.

Skills for Health CompetencesPHP35, BA3, PHP40, Gen79

3. Ear nose and Throat nursing competences

Practice and service development

Indicative Key Stage Framework (KSF) dimension – Core 4 Service improvement


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Contextual factors

7 Formulates policy, standards and care delivery strategies related to the care and management of adults with ENT conditions.

Core 4 Level 3

Core 4 Level 4.

All policies and standards used in service delivery are current and valid.

Accurate and comprehensive documentation pertinent to innovations implemented and evaluated within the practice setting.

Policy development. Standards development. Partnership working. Research/innovations in ENT care.

Evaluation processes. Critical analysis. Audit processes. All available information and processes applicable to the innovations adopted within the practice setting.

Actively develops and influences local and national ENT practice.

Skills for Health CompetencesPHP35, BA3, PHP40, Gen30


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Level Competence KSF Performance criteria Knowledge and understanding


Contextual factors

5 Participates in education of patients, carers and junior nursing staff in the management of ENT conditions.

Core 2 Level 3

Patient documentation clearly states the education provided to the patients and appropriate others.Ward information file contains current information in relation to the management of ENT. Engages in teaching programmes.

Teaching and assessing adults. Anatomy and physiology of normal ear nose, throat, head and neck. Pathophysiology of ENT conditions, their care and management.

Empathetic. Effective communicator. Seeks advice and guidance. Checks understanding. Good practical demonstrator.

Patient support networks for ENT/aural conditions e.g.NMC (2008) standards to support learning and assessment in practice.

ENT RCN networks to discuss best practice.

Skills for Health Competences, CHS56, CHS58, GEN18, GEN84, SC0023, PE6, PE7, LADD10.LADD13 PE8.

6 Leads/provides group education and training of patients, carers, nursing staff and other professionals in the management of ENT conditions

G1 Level 3

Record of training plans, evaluation forms and handouts in addition to the requirements for Level 5.

Alert to individual learning needs within groups. Tailors education delivery to the needs of the individual.

CHS152Evidence based approachesCochrane reviewsNational and international guidelines

7 Leads and develops specific education and training programmes for patients, carers, nursing staff and other professionals across all care sectors, including teachers, peers and lay carers in the management of ENT conditions.

G1 Level 4

Evidence of contribution to local and national programme/guideline development as a contributor.

Educational Programme Development. Training needs assessment.

Actively utilises all opportunities to educate others.

LADD13LADD05Lead on programmes of learning

Teaching and educationIndicative KSF dimension: G1 Learning and development


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4. Specialist psychological/ psychosocial/ physical interventions



Contextual factors

5 Identify patients within their care who may require additional support to manage long term health outcomes.

Core 1 Level 3 HWB2 Level 3

Patient records identify actual and potential needs and referral process initiated and recording of discharge planning.

Essential counselling and communication skills. Potential psychosocial impact of chronic ENT conditions. Roles and responsibilities of members of the multi-disciplinary team. Referral pathways available to area of practice. Knowledge of primary health care services.

Empathetic. Listens effectively. Recognises the impact of the patient’s condition on Individuals. Approachable. Recognise the need for openness and honesty regarding treatment options and side-effects.

Common assessment framework consent.Skills for health PE8 Skills for Health Competences CHS76 CHS98 Skills for Health Competences CHS98, CHS56, CHS55

Action on hearing loss factsheetsOn website

ENT UK patient leaflets.

Hospital/ local leaflets

Local support groups e.g. Laryngectomy associations

Allergy UKwww.allergyuk.org/

6 Counsels patients about long term health outcomes on a proactive basis, liaising with other members of the multidisciplinary team.

HWB7 Level 3

Patient records demonstrate a clear plan of action implemented to address actual and potential needs and all communication with the patient. Records further referral to other professionals applicable to the person’s need. Initiates and implements discharge planning.

Long term health outcomes applicable to ENT conditions present with within your area of practice. Ensure an information provided is applicable and understandable

Communicates effectively. Actively engages relevant individuals. Actively seeks out relevant information.

Counselling and consultation Indicative KSF dimension: HWB5 provision of care to meet health and wellbeing needs, HWB7 assessment and treatment planning


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Contextual factors

7 Develops, implements and evaluates a variety of counselling and supportive approaches within the multidisciplinary team

HWB7 Level 4

Patient records clearly identify need, action implemented, anticipated outcomes and evaluation of impact over time. Patient records identify where expert psychological input is indicated and requested. Facilitates discharge planning and referral to other agencies.Information available and applicability/relevance to age group and level of understanding of child/young person. Care pathway applicable to patient.


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Assessment, investigation and treatment Indicative KSF dimension: HWB6 Assessment and treatment planning and HWB7 Interventions and treatments.



Contextual factors

5 Assesses patients in relation to the management of their ENT conditions.

HWB2 Level 3

HWB6Level 3

Accurate and comprehensively completed assessment of the patient recorded inthe patient’s records. Clear documentation of any ENT condition that deviates from normal, to whom reported, the advice obtained and action taken.

Anatomy and physiology of normal ear nose and throat. Who to report identified deviations from normal ear, nose and throat and seek advice.

Understand patient self measures that improve

Recognition of own limitations. Adhering to the NMC The Code.

Following of local protocols and guidelines

NMC The Code. Tools to support documentation of assessment.

Skills for health:CHS20, CHS168CHS38, CHS39

Able to perform otoscopy safely

ENT conditions Prompt referral of problems to specialist team.

Provides information.

Clear documentation of the provision of accurate information specific to the needs the patient with evidence of checking understanding and seeking further advice as required.

Information available. How to access and use information relevant to the needs of the adult and carers.

Ensures knowledge and practice is current and reflects best practice.

Skills for Health Competencies Hospital patient leafletsENT UK leaflets

Assists with required investigations.

HWB5 Level 3 HWB8

Effectively engages with the patient and their family/carers, reducing their anxiety and addressing any concerns identified. Refers to more experienced specialist nurse as required ensures theperson undergoes the required investigations safely.

Relevant ENT investigations, their relevance and how they are undertaken.Actual and potential risks/complications associated with the required investigations. The role and responsibilities of the nurse in assisting with the investigation. How to prepare the patient for the investigation.Knowledge and ability to collect specimens


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Assessment, investigation and treatment Indicative KSF dimension: HWB6 Assessment and treatment planning and HWB7 Interventions and treatments.



Contextual factors

6 Undertakes nurse-led assessment.

HWB6 Level 3

Documentation clearly shows an accurate and comprehensively completed assessment of the adult and their ear nose and throat condition/problem. Identification of the impact of the condition on the adult/family.

Consider how other co- morbidity impact on the assessment made.

Able to perform core clinical examination safely and effectively. Nasal, aural and oral

Anatomy and physiology of normal ear nose and throatPathophysiology of commons ENTconditions.

Physiological investigations used in ENT nursing and how they are undertaken.

Where, and how, to access support and advice.

Accuracy

Systematic approaches

Consistency

Seeking advice

Hospital protocolsNMC The Code 56

Tools to support documentation of assessment.

Skills for health:CHS20, CHS56, PE4, CHS152, CHS167

Evidence based approaches

ENT Cochrane reviews

Requests simple investigations

Know when simple investigations such as audiogram are necessaryRecords show relevant investigations implemented

Understand the fundamental principles of simple investigations such as audiograms core blood tests and ECG

Patient SafetyTimely investigations

Working with other departments: Audiology microbiology, pathology and imaging

Formulates, implements and evaluates a plan of care in conjunction with the multi-disciplinary team (MDT).

HWB6 Level 3

Patient documentation clearly shows the involvement of all relevant practitioners and their contribution to the plan of care. The plan of care clearly relates to all actual and potential needs identified in the nurse-led assessment.

Patient records demonstrate clear implementation and ongoing evaluation and reassessment.

The roles and responsibilities of the MDT members and their individual contribution.

Referral mechanisms and pathways available and how to use them.

Understand how surgical and pharmacological treatments can be adjusted to clinical findings and how this impacts on care delivery

Local service providers, e.g. social services, education, etc. Common assessment framework.

Skills for Health Competences CHS4, GEN79. CHS55, PHARM29, CHS 89


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Contextual factors

7 Undertakesnurse-led assessment and treatment clinics independently

Engages in MDT working Steers/leads planning and treatment decisions

HWB6HWB7 Level 4

Ability to competently assess ear nose and throat recognising deviation from the norm and formulation of diagnosis and treatment plan.

Understand and recognise common and complex ENT conditions

Understand the range of treatment and care options

Refers to other senior members of the ENT team when needed. Contribute to MDT

Anatomy and physiology of normal ear nose and throat. Pathophysiology of common and complex ENT conditions treatments and predicted outcomes of their use.

Demonstrate ability to carry out treatment appropriately and timely

Understand limitation of equipment. Demonstrate knowledge to use safely and skilfully

Safety AdvocacyPatient empowermentInvolvementCollaborationGovernanceDecision makingConsent

Local protocols Skills for Health Competences as above and CHS47, CHS83, PE1, CHS225, CHS40, CHS41, CHS44, CHS 167,EUSC37 (nasal bones only)

Cochrane ENT reviewsE.g. intervention on otitis externa (2010)

Ability to follow treatment plan through to conclusion or develop a long term management plan

Use PGDs or be independent non medical prescriber


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Contextual factors

7 HWB6HWB7 Level 4

Know when and what investigations are appropriate to use in aiding diagnosis or guiding care Understand results of investigations

Understand the implications of consent

Understand the fundamental principles of a range of investigations and how they relate to normal and altered anatomy and physiology.

Know when to refer and seek adviceUse of investigations to confirm or endorse a diagnosesBe able to interpret and act on resultsUnderstand the results of image reports and actUnderstanding of Bolam and Montgomery guidelinesImpact of Lord Fraser Guidelines

Cost effectiveness

Cross boundary working

Patient involvementAwareness of treatment implications and options

Local and national pathology and radiology guidelines Skills for HealthCHS178

Full understanding of IMER and imaging requesting rules (2000, 2006, 2011, 2017)

The use and understanding of audiology studies

Antibiotic stewardship.Mirco-guide Apps

Legal case studies

Provide patients with a range of treatment options

Know what treatment and care options are available for patients with a given ENT condition

Impact of consent issues

Be able to access a comprehensive range of information and provide explanation to enhance patient involvement.

Legal issues, frameworks and case law (as above)

Empowerment Evidence based approaches.

CHS56

Trust policies on delegated consent


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Lifestyle Indicative KSF dimension: HWB4 Enablement to address health and wellbeing needs.



Contextual factors

5 Provides support, information and advice on adult lifestyle changes, referring to ENT team as appropriate.

HWB1 Level 1

ENT Documentation shows effective liaison with relevant personnel.

Use of patient information leaflet systems including Patient Information Prescriptions. Undertake Quality of Life assessments.

Anatomy and physiology of the ear nose and throat. Normal ear nose and throat function.

Knowledge of appropriate leaflets to use.

Be able to explain to patients the importance of lifestyle changesE.g. smoking secession Voice rest, ear care, allergen exposure Recognise potential stressors on ability to manage the ENT condition. Strategies to address any deviation.

Enabling. Empowering. Supportive. Empathetic. Health promotion

Patient support networks – see appendix. DH guidelines re education. Skills for Health Competences. CHS56GEN98, PE1ENTUK.org.uk

6 Provides support, information and detailed advice on lifestyle changes and long-term implications of ENT conditions referring to other members of the ENT team as appropriate

HWB1 Level 3 HWB4 Level 3

Local educational policy in relation to health needs. Skills for health competences PE8

7 Addresses requirements to, developing the care pathway in conjunction with the MDT. Implementing support programmes

Devise patient information packs/leaflet

HWB4 Level 4

Documentation shows effective liaison with MDT members, and identifies difficulties and resultant action taken.

Provide ongoing support or information systems

Referral pathways for psychosocial interventions.

Recognise when to refer and make referralsE.g. to other CNS, SALT and others

DH guidelines re education. Skills for Health Competences. CHS128, CHS173


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Management of deterioration in pre-existing ENT conditionsIndicative KSF dimension: HWB7 Interventions and treatments



Contextual factors

5 Recognises signs of deterioration of ENT conditions and implications for management.

HWB6 Level 3

Patient documentation clearly demonstrates recognition of signs of deterioration and referral to specialist ENT team.

Recognise and manage critically deterioration patients

Patient documentation clearly demonstrates recognition of signs of deterioration and referral to specialist ENT team.

Recognise and manage critically deterioration patients

Observant. Promptly reports and records any concerns.

Collegiate working

Skills for Health Competences CHS163National Early warning score (NEWS)Sepsis pathway action

Resuscitation council.www.resus.org.uk

6 Instigates management investigations and treatment applicable to the nature of deterioration.

HWB7 Level 3

Patient documentation clearly records the instigation of the correct investigations and treatment according to local policies/ procedures/ protocols.

Recognise and manage critically deterioration patients. Guide others in the management of acute situations

How to recognise the adverse effects of invading organisms, medications, environmental and other triggers on ENT conditions and relevant investigations. Treatment regimes available.

Understand and take measures to protect the deteriorating airwaySeek help Indications for the instigation of treatment. Side-effects and complications with identified treatments (actual and potential).

Ensures appropriate actions implemented in response to concerns reported.

Skills for Health Competences CS13. CHS225 GEN30, CHS44, CHS178, CHS38

NHS evidencewww.evidence.nhs.uk

Adjusts treatment according to local protocols, as appropriate.

Patient documentation clearly demonstrates adherence to local protocols.

Local protocols relating to the adjustment of treatment regimes. For example deteriorating ear condition.

Local protocols.

Skills for Health Competences EC11k CHS47. GEN 30


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Contextual factors

7 Provides advice on care/management with unusual/difficult cases or multiple conditions.

Manages deteriorating patientslocally and nationally recognised expert in ENT conditions.

HWB7 Level 4 Core 1 Level 4

A recognised expert and used as a resource in identification ENT conditions.

Guides other as a team leader

Anticipates potential deterioration

In-depth knowledge of ENT conditions.

Understanding and knowledge of prevention of exacerbations of conditions

Seeks senior and other expert helpEg ENT Consultants

Approachable. Guides others. Effective communicator. Confident. Decisive. Instils confidence in others. Self aware.

NHS evidencewww.evidence.nhs.uk

Cochrane ENT reviews

Action on findings eg NEWS and sepsis scoresDiagnose and treat


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Teaching self care skillsIndicative KSF dimension: HWB4 Enablement to address health and wellbeing needs.



Contextual factors

5 Supports the adult and carers in managing the condition.

HWB4 Level 2

Patient records demonstrate appropriate information, advice and support provided to the adult to address their needs in managing their ENT condition, including seeking advice/support from expert specialist practitioner.

Basic technical and theoretical knowledge of ENT conditions, their management and treatment.

Approachable. Supportive. Good practical demonstrator. Good communicator. Enabling.

Patient support networks. Skills for Health Competences PE4.

Patient legal responsibilitieseg. DVLA

6 Facilitates adults empowerment by assessing and teaching them, technical knowledge and theoretical understanding of management of ENT conditions.

HWB4 Level 3

How to assess the adults and their family’s training needs treatments. Technical and theoretical management ENT conditions.

Effective communicator. Empowering. Knowledgeable.

7 Facilitates adults Empowerment by assessing and teaching essential and more complex knowledge and theory to aid understanding of self management, including recognition of exacerbations and infections.

HWB4 Level 4

Used as a resource to empower the adult, carers in the self management of their ongoing condition

Assessment of the adults training needs to enable self managementEg tracheostomy tube management


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Specialist clinical interventions Topical/systemic treatments – Indicative KSF dimension: HWB7 Interventions and Treatments



Contextual factors

5 Applies treatments as per prescription.

HWB5 Level 3

Correctly applies/ administers treatment. Correct completion of the prescription documentation. Patient records clearly demonstrate evaluation of the medication.

Understand the role and how to monitor the effect of systemic treatments. Who to contact for specialist advice/support.

Good communicator. Supports the adult to ensure that the treatment is applied correctly. Practical.

Skills for Health Competences.

AH12, Pharm29

NMC Standards for medicine management (2007)

Use of PGDs

6 Assess adjusts treatments according to adults individual needs, adhering to local protocols.


Patient documentation clearly demonstrates adherence to local protocols.

Use of PGDs or individual patient treatment plans

Knowledge of local protocols and procedures covering sphere of practice. Knowledge of systemic treatments used to inform clinical judgements.

Observant. Knowledgeable. Confident.

Medicines and healthcare products regulatory agency (MHRA)

7 Assesses and adjusts ENT treatments. Makes autonomous decisions before medical consultation


Patient documentation clearly demonstrates correct assessment of the adults condition and the resultant appropriate adjustment to the treatment regime.

Use PGDs or be independent non medical prescriber

Knowledge of systemic and topical treatments to make informed clinical judgements.

Knowledge and understanding of applied pharmacology and how this relates to ENT conditions

Decisive.Decision makingEvidence based

Registered Non Medical PrescribingRevalidation reflection on prescribingUpdates of practice

NMC (2006 up date 2011) standards in prescribing


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5. Skills for Health Competences and referencesAction on Hearing Loss (2017) Patient leaflets [available online] www.actiononhearingloss.org.uk/how-we-help/information-and-resources/publications/hearing-health/

Action on Hearing Loss (2015), Hearing Matters, Action on Hearing Loss, London www.actiononhearingloss.org.uk/supporting-you/policy-research-andinfluencing/research/hearing-matters.aspx

Burton M, Aaron , Warner L. (2016) Ear drops for the removal of wax. The Cochrane collaboration. John Wiley and son Ltd.

Casey M, Cooney A et al (2017) Nurses’, midwives’ and key stakeholders’ experiences and perceptions on requirements to demonstrate the maintenance of professional competence. Journal of advanced nursing; vol. 73 (no. 3); p. 653-664.

DH (2004) The NHS Knowledge and skill framework (NHS KSF) and the development review process. HMSO.

DH (2000 (Updated 2011)) Ionising Radiation (medical Exposure) Regulations (IMER)

DH (2000 (Updated 2017)) Ionising Radiation (medical Exposure) Regulations (IMER): Notes on good practice.

Health and Safety Executive (2017) www.hse.gov.uk/competence/what-is-competence.htm

Kaushik V. et al (2010) Interventions for acute otitis externa. The Cochrane collaboration. John Wiley and son Ltd.

NHS employers (2017) www.nhsemployers.org/SimplifiedKSF

Nursing Midwifery Council (2016) http://revalidation.nmc.org.uk/welcome-to-revalidation [online]

Nursing Midwifery Council (2015) The code: Professional standards of Practice and behaviour for nurses and midwives, London: NMC.

Nursing and Midwifery Council (2014) Standards for competence for registered nurses, London: NMC

Nursing Midwifery Council (2007) Standards for medicine management, London: NMC

Nursing Midwifery Council (2006) update 2011 Standards of proficiency for nurse and midwife prescribers, London: NMC.

Roach S (1992) The human act of caring: a blueprint for the health profession (revised edition), Ottawa: Canadian Hospital Association Press.

Royal College of Nursing (2017) www.rcn.org.uk/professional-development/professional-services/credentialing


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All Skills for Health Competences referred to in this document are available from: www.skillsforhealth.org.uk. These are found within the National occupational standards tab.

Those referred to are:

SfH code Competence title

AH12 Enable individuals to take their medications as prescribed.

BA3 Contribute to the development of organisational policy and practice.

CHS20 Undertake examination of the external ear.

CHS38 Plan assessment of an individual’s health status.

CHS40 Establish a diagnosis of an individual’s health condition.

CHS41 Determine a treatment plan for an individual.

CHS44 Plan activities, interventions and treatments to achieve specific health goals.

CHS47 Monitor and assess patients following treatment.

CHS52 Plan interdisciplinary assessment of the health and well-being of individuals.

CHS55 Facilitate the individual’s management of their condition and treatment plan.

CHS56 Provide clinical information to individuals.

CHS83 Interpret the findings of healthcare investigations.

CHS89 Evaluate treatment plan with individuals and those involved in the care.

CHS98 Arrange services and support with other healthcare providers.

CHS120 Establish an individual’s suitability to undergo an intervention

CHS128 Develop evidence based clinical guidelines

CHS152 Assess an individuals communication skills and abilities.

CHS163 Manage emergency situations

CHS167 Obtain valid consent or authorisation.

CHS168 Obtain a patient/client history.

CHS178 Determine investigations required to meet a clinical need

CHS185 Perform basic specimen/sample collection

CHS225 Implement a treatment plan.

EC11K Investigate and diagnose an individual presenting for emergency assistance with ear nose or throat problems.

EUSC37 Re-align nasal bones

GEN30 Manage patient flow

GEN79 Coordinates the progress of individuals through care pathway

GEN98 Promote effective communication in a healthcare environment.

LADD03 Evaluate and improve learning development provision.

LADD04 Plan and prepare specific learning and development opportunities.

LADD05 Develop and prepare resources for learning and development.

LADD10 Reflect on, develop and maintain own skills and practice in learning and development.

LADD13 Plan and prepare learning and development programmes.

PE1 Enable individuals to make informed healthcare choices and decisions.

PE4 Agree a plan to enable individuals to manage their health condition.

PE6 Identifying the learning needs of patients and carers to enable management of a defined condition.

PE7 Develop learning tools and methods for individuals and groups with a defined health condition.

PE8 Enable individuals to manage their defined health condition.

PHARM29 Take a medication history.

PHP35 Advise how health improvement can be promoted in policy development.

PHP40 Evaluate and recommend changes to policies to improve health and wellbeing.

SC0023 Developing your knowledge and practice.


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(All accessed checked Nov 2017)

British Association of Otorhinolarnygology head and neck Surgery. www.ENTUK.org.uk

British Society of audiology www.thebsa.org.uk

Department of Health National Service Framework: www.dh.gov.uk/en/Healthcare/NationalServiceFramework

DVLA driving with medical conditions www.gov.uk/browse/driving/disability-health-condition

Ear Atlas www.earatlas.co.uk

Medicine and healthcare product regulatory agency www.mhra.gov.uk

National Eczema Society: www.eczema.org

National Institute for Health and Clinical Excellence (NICE) www.nice.org.uk

NHS evidence www.evidence.nhs.uk

Nursing Midwifery Council www.nmc.org.uk

Patient UK (health information): www.patient.co.uk

The Resuscitation council (UK) www.resus.org.uk

Royal College of Nursing: www.rcn.org.uk

Action on hearing loss. Formally Royal National institute for the deaf www.actiononhearingloss.org.uk

Skills for Health www.skillsforhealth.org.uk

The Cochrane library www.thecochranelibrary.com/view/0/index.html

6. Useful organisations and their websites

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The RCN represents nurses and nursing, promotes excellence in practice and shapes health policies

RCN Onlinewww.rcn.org.uk

RCN Direct www.rcn.org.uk/direct

0345 772 6100

Published by the Royal College of Nursing20 Cavendish Square

London W1G 0RN

020 7409 3333

April 2018Publication code 006 854

Documents

RCN competences · Ear, Nose and Throat (ENT) disorders are common adults and health professionals frequently encounter them. ENT disorders can vary from minor transient conditions