RCN OrthoTrauma comp insides - Royal College of … COLLEGE OF NURSING 1 Ophthalmic nursing: an integrated career and competence framework 1. Introduction 2 Application 2 How to use

Ophthalmic nursing:

an integrated career andcompetence framework

RCN CompetencesRCN Competences

This publication is supported by industry

Foreword This competence framework has been revised and updated byophthalmic nurses who are keen to share their knowledge andexpertise with other colleagues within the specialty. It shouldprovide the busy ophthalmic nurse with a structured frameworkagainst which they can map their own competences, plus helpintegrate them into a professional portfolio to show growth anddevelopment (both personally and professionally). Thiscompetence framework will work across a variety of ophthalmiccare settings.

It is recognised that ophthalmic nursing is a dynamic andexpanding area of practice and, as such, it is not always possibleto capture every competence or new role function; there willalways be room to identify new, or modify, existing competences.The document will be reviewed in 2015, or sooner if newevidence or guidelines are published. If you have any commentsor queries about this competence framework please contact amember of the RCN Ophthalmic Nursing Forum SteeringCommittee.

Mary E ShawChair, Ophthalmic Nursing Forum

[email protected]

RCN Legal Disclaimer

This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers areadvised 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 beenmade to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which itmay 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 causeddirectly 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

© 2012 Royal College of Nursing. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmittedin any form or by any means electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Publishers. Thispublication 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 whichit is published, without the prior consent of the Publishers.

Novartis UK Limited provided an educational

grant to support this publication, but had no

influence over the content.

Kindly sponsored by SD Healthcare Ltd

R O Y A L C O L L E G E O F N U R S I N G

1

Ophthalmic nursing: an integrated career and competence framework

1. Introduction 2

Application 2

How to use this framework 2

Conclusion 2

2. Ophthalmic nursing competences 4

Core competence 4

Outpatient department 8

Ophthalmic theatre 13

Inpatient settings 17

Ambulatory care/day case 19

Children and young people 23

Emergency department 27

3. References and further reading 29

Contents

2

R C N C O M P E T E N C E S – O P H T H A L M I C N U R S I N G

Introduction

Application

This competence framework was developed by expertnurses in the RCN Ophthalmic Nursing Forum using aconsultation and consensus process and drawing oncurrent evidence and literature.

The framework focuses on what ophthalmic nurses arerequired to do for their patients and the knowledge, skillsand interventions that are specific to the diverse areas inwhich ophthalmic nurses work. Although the intention isfor this competence framework to have a stand-alonefunction, it should be used in conjunction with otherframeworks that focus on core competences for allqualified nurses, such as the RCN’s Integrated core careerand competence framework for registered nurses (2009a).

The framework has three levels of competency. It buildsthrough the levels as the ophthalmic nurse develops frombeing a registered nurse to being a competent ophthalmicnurse (level 1), to specialist ophthalmic nurse (level 2), to advanced ophthalmic nurse practitioner (level 3). It isintended that each ophthalmic nurse should achievecompetence in level 1 as these are core to the role. As theirexpertise develops further, they will achieve competence at level 2 linked to the specialist area of practice of theirwork. Those that develop their practice to an advancedlevel will achieve competence at level 3.

Level 1: Competent ophthalmic nurse.

Level 2: Specialist ophthalmic nurse.

Level 3: Advanced practitioner/consultant ophthalmic nurse.

The framework will:

� help individual nurses plan their professionaldevelopment in the ophthalmic setting

� act as a model of care for ophthalmic patients, for useby nurses in other settings (for example, primary andcommunity care)

� provide guidance to employers about expectations ofcompetency at different levels of ophthalmic nursingpractice

� act as a framework for educationalists to use whenplanning and revalidating educational provision toreduce the theory/practice gap and supportconsistency across the ophthalmic sector

1� capture the unique contribution to care that

ophthalmic nurses make

� provide a model for use in the development of newophthalmic nursing roles, such as those in primarycare or in visual rehabilitation

� provide a structure for career progression in relation toophthalmic nursing.

How to use the framework

This document is intended to complement the RCNintegrated core career and competence framework andfocuses on specific nursing interventions. The frameworkshould be used as a developmental tool and to manageperformance across the nursing profession. It should alsobe used in combination with generic competenceframeworks for registered nurses and for those workingwith children and young people – these core competencesare not repeated in full, although relevant parts areincluded to show the scope of ophthalmic nursing practice.

The ophthalmic nurse will be required to produceevidence for each competency in order to demonstrate thatthey have achieved the competence at theidentified/desired level. Forms of evidence includeacademic programmes, case histories and appraisals via areflective diary, 360 degree feedback, and verification ofpractice and structured observation of practice. It isstrongly recommended that they access some of therecommended reading when mapping their competence.

Any nurse working in an ophthalmic setting can use thisframework: the core competences have been written sothat, whatever the setting, most will be achievable.Specialist competences will enable each nurse to map theircompetence to a continuing dynamic range of practice.

Conclusion

This competence framework is not a list of competences tobe collected but a framework for showing competences atdifferent levels of expertise in different ophthalmicsettings. Not all nurses will have all the competences in aparticular area and some will have many in a number ofdifferent areas. Nurses should map their competences toassess their current level of practice and, using thecompetence framework, plan their own professionaldevelopment. The framework can also be used in planningteam development. It is expected that this framework willbe widely adopted by nurses working in ophthalmicsettings in the UK.


3

Level 1Competentophthalmic nurse

• Assesses patient need.

• Appraises the evidence to support practice.

• Becomes a competent practitioner.

Level 2Specialistophthalmic nurse

• Promotes evidence based practice in own service.

• Develops the practice of the competent practitioner in own unit.

• Develops own practice.

• Participates in local nursing development and audit groups.

Level 3Advancedophthalmic nurse

• Is involved in strategic planning for eye services both locally and nationally.

• Is recognised as a leader in practice development.

• Is an autonomous practitioner.

• Instigates evidence based changes in practice.

The diagram follows Benner’s framework (1984) and demonstrates that a new ophthalmology nurse (a novice) will show

evidence for their increasing competence. Within each level of competence, there are both core and specialist competences.

Core competences, no matter what level of the nurse’s practice, are fundamental to the delivery of ophthalmic care. The

competence framework is organised to reflect these levels and settings/client groups i.e. core ophthalmic nursing

competences; competences for ophthalmic outpatient department, theatre, inpatient settings, ambulatory care, emergency

department and children and young people.

Diagram: progression through the levels of practice

Consultant nurse/advanced practitioner

Specialist/experienced

Competentophthalmic nurse

New toophthamology

Children and young people

Adult and elderly

Ambulatory care

Inter-professional working

Outpatient care

Peri-operative care

Inpatient care

Emergency care

Primary care

4


Ophthalmic nursing competences

Core competence: competent ophthalmic nurse

Level Competence Performance criteria Knowledge andunderstanding

Contextual factors

1 Adopts a critical approachto ophthalmic carethrough reflection onpractice.

Demonstrates critical thought andreflection through discussion of clinicaldecision making with regard to specificophthalmic patient care.

Knowledge of acquisition ofresearch evidence andapplication in practice.

Evidence-basedpractice.

Applies theirunderstanding of thephysiological,pathological,psychosocial,pharmacological andcultural to meet theophthalmic patient’sneeds.

Demonstrates knowledge andapplication of ophthalmic anatomy andphysiology, pathophysiology andpharmacology in practice thoughpatient education.

Acts as the patient’s advocate inmaintaining their dignity in careprovision.

Ophthalmic anatomy andphysiology, pathophysiologyand pharmacology and how itrelates to the person and visualfunction.

Awareness of cultural influenceson care requirements.

Awareness and understandingof the specific needs of thepartially sighted or blind person.

Health promotion.

Holistic care.

Diversity in caring.

Spiritual care.

Selects appropriatestrategies for assessing,planning, implementingand evaluating the care ofthe ophthalmic clientgroup.

Demonstrates knowledge andunderstanding of the appropriateapplication of the nursing process andnursing models/care pathways to careprovision.

The nursing process.

Nursing models, eg Roper,Logan and Tierney/Orem/Jones.

Health promotion models.

Patient pathways.

Nursing practice.

Caring and empathy.

Multidisciplinaryteam working.

Communication.

Applies appropriate legal,ethical and professionalrequirements to thedelivery of care of theophthalmic patient.

Demonstrates professional practice inkeeping with their professional bodyand local policies.

Awareness of medico-legal andethical issues.

Accurate and timelydocumentation.

Quality in nursinginterventions.

NMC Code of conduct(2008).

Hospital policies, eginfection control andconfidentiality.

Portfoliodevelopment.

Adopts and employsappropriate strategies toprovide a safeenvironment for theophthalmic patient.

Works safely and effectively. Monitors the welfare, health andsafety of self and other people.

Awareness of risks and actionsto be taken.

Health and safety atwork.

Works effectively andefficiently with membersof the interdisciplinaryteam (IDT) when caring forophthalmic patients.

Demonstrates knowledge of the natureof alternative roles within the careteam.

Communicates effectively to providebest quality care from the mostappropriate professional.

Knowledge of the roles of:• ophthalmologists• optometrists• orthoptists• pharmacists.

Appropriate and timely referrals.

Preceptorship.

Delivers care that issensitive to the patient’sneeds in the context of amulticultural and dynamicsociety.

Demonstrates an awareness of thediffering needs of people, eg age, race,gender, disability.

Knowledge of:

• disability discrimination

• spiritual needs

• special needs andrequirements of the visually andmultiply disabled person.

Works in accordancewith relevantlegislation andnational and localpolicies andprocedures.

See also, RCN integrated core career and competence framework for registered nurses (RCN, 2009a). With eachcompetency level The nature, scope and value of ophthalmic nursing (RCN, 2009b) applies throughout.

2

Core competence


5

Core competence: competent ophthalmic nurse


Contextual factors

1 Organises and justifiescare appropriate to theneeds of thoseexperiencing loss andgrief, and manages theirongoing psycho-socialneed.

Demonstrates understanding of thegrieving process and application topractice in the ophthalmic setting.

Emotional maturity.

Empathy.

Kubler-Ross Model.

Demonstrates an ability tocompetently performspecific ophthalmicclinical skills relevant torole.

Demonstrates appropriate knowledgeand understanding of a range ofspecific diagnostic and therapeuticskills.

Selected skills from the listbelow.

� Able to recognise and describe signs of commonconditions in your area of practice, using a limitedrange of terminology.

� Understands the principles of managing people withophthalmic conditions and trauma.

� Administers and provides advice on the pharmacologyof commonly used drugs in own area of practice.

� Understands the legal issues around the supply andinstillation of ophthalmic medications.

� Demonstrates an understanding of the terms myopia,hypermetropia and astigmatism, and explains howthese refractive errors are corrected.

� Demonstrates an understanding of the principlesinvolved in magnification.

� Demonstrates an understanding of concave and convexlenses used as low visual aids.

� Demonstrates an understanding of how the usage of adifferent light source can enhance print on a pagewithout the use of magnification and be able to advisethe patient on suitability and choice.

� Identifies how the use of different colours, textures andcontrasts may help the visually impaired patient.

� Accurately assesses all patients and recognises actualand potential problems that might require attention.

� Builds up a picture of, and accounts for, the widersituation when assessing and relating to patients.

� Can carry out basic ophthalmic investigations.

� Demonstrates effective techniques of eye examination,including pen torch examination.

� Demonstrates the ability to assess visual function.

� Assesses the ability and motivation of the patient andcarer.

� Takes eye swabs and understands:

� eye care as a clean or an aseptic procedure

� eye padding and bandaging

� ocular irrigation

� contact lens care including bandage contact lens

� Schirmer’s tear function test.

� Uses knowledge of abnormal ocular physiology toanticipate effects on the person’s vision.

� Demonstrates an understanding of how vision is usedin daily living skills and other tasks.

� Knowledge of a range of equipment (magnifiers,spectacles, monoculars and high-tech equipment suchas computers).

� Understands how eccentric fixation, eccentric viewing,steady eye strategy and the use of typoscopes arerelevant to the needs of some visually impairedpatients.

� Demonstrates knowledge of colour, contrast sensitivity,and the use of light for the visually impaired patient.

� Demonstrates knowledge of how the environment mayaffect patients with a visual impairment.

Clinical skills for the competent ophthalmic nurse (this is not intended to be an exhaustive list)

6


Core competence: specialist ophthalmic nurse


Contextual factors

2 Functions autonomouslyto deliver healthoutcomes, for theophthalmic patient withina quality framework.

Uses a full range of nursing strategiesto maximum effect in the managementof patient care.

Structured approach to clinicalinterventions.

Interprets clinical signs,symptoms and test results.

Treatment and care plansimplemented and evaluated.

NMC Code of conduct(2008)

Local qualityframework.

Releasing time tocare.

Empowers others todeliver evidence-basedcare whilst developingtheir own practice.

Acts proactively as an educator andresource to others.

Accountability in delegation.

Effective leadership.

Teaching and learningstrategies.

Local leadershipcourse.

Mentorship.

Manages and evaluatesclinical practice to ensuresafe, evidence-based care.

Assesses, prioritises and plans forpatients presenting with a range ofophthalmic conditions care.

Assimilates data gathered andprovides a rationale fordiagnosis and care.

Clinical audit.

Demonstrates effectiveleadership andsupervisory skills tosupport servicedevelopment andinnovation.

Is identified as, and leads on, theimplementation of local and nationalguidelines/initiatives.

Is aware of differentmanagement strategies andstyles.

Is aware of, and practices, theskills needed when leading ateam.

Acts as a role model.

Coaching andleadership.

Clinical audit.


Actively contributes to thedevelopment andmaintenance of aneffective clinical learningenvironment.

Demonstrates a clear ability to providean excellent environment for clinicallearning, support and development.

Provides knowledge of theneeds of those requiringsupport and provides a suitablelevel of clinical support tocolleagues and patients.

Mentorship.

Demonstrates an ability tocompetently performspecific ophthalmicclinical skills relevant torole.

Demonstrates specialist knowledge andunderstanding of a range of specificdiagnostic and therapeutic skills.


� Assesses, prioritises and plans care for patientspresenting with a range of ophthalmic conditions andtrauma.

� Uses the slit lamp to aid diagnosis.

� Applanation tonometry: Goldmann, Perkins, ICare andTonopen XL.

� Performs biometry (contact or non-contact).

� Performs keratometry.

� Performs focimetry (manual and automated).

� Performs lacrimal sac washout.

� Acts proactively as an educator and resource to otherprofessionals within, and outside, the ophthalmicsetting.

� Removal of sub-tarsal foreign body.

� Fundus fluorescein angiography.

� Performs ocular coherence tomography (OCT).

Clinical skills for the specialist ophthalmic nurse (this is not intended to be an exhaustive list)


7

Core competence: advanced ophthalmic nurse


Contextual factors

3 Utilises theoreticalframeworks for clinicaldecision making anddiagnostic reasoning.

Accurately conducts an ophthalmicassessment and appropriate physicalexamination, then interprets findings.

Initiates and interprets tests andinvestigations.

Uses expert knowledge toassess, plan and implementcare/treatment.

Ongoing professionaldevelopment.

Analyses individual,professional andorganisational (local andnational) influences onleadership andcollaborative practice.

Adheres to organisational and nationalguidance.

Maintains an up-to-date knowledge ofconditions, treatments and guidelinesto inform care.

Effectively leads developments in careand management in own workplace.

Uses expert knowledge tocontribute to local and nationalinformation, data collection andnetworks.

Clinical audit of ownpractice.

Professionalnetworking.

Publishing.

Exercises professionalaccountability whendeveloping self andothers.

Creates and utilises learningopportunities in care delivery toenhance own practice and that ofothers.

Acts as a coach and mentor toothers whilst maintaining ownprofessional portfolio andactively involved in their ownappraisal/360 degree feedback.


Professionalindemnity.


Mentorship/coaching.

Teaching andlearning.

Uses quality frameworksto evaluate and developpractice and serviceprovision.

Ensures that own practice is currentand is linked to an action plan toenhance the quality of care provision.

Demonstrates a wide knowledgeand understanding of serviceframeworks anddivisional/national plans.

Demonstrates an appreciation ofservice improvements andinnovations that will impactpositively on patient care.

Clinical audit.

Clinical research.

Critical reflection onpractice and service.

Demonstrates an ability toexpertly perform specificophthalmic clinical skillsrelevant to role.

Demonstrates appropriate knowledgeand understanding of a range ofspecific diagnostic and therapeuticskills.


� Initiate, supply, administer and evaluate effects ofpharmacological interventions – in line with nationaland local policy and clinical guidelines.

� Able to prescribe medication in line with currentlegislation and Department of Health (DH) standards.

� Uses expert knowledge to create and promote creativeand innovative solutions to practice problems.

� Is able to translate expert knowledge into formsavailable to all grades of ophthalmic and non-ophthalmic staff in terms of training and education.

Clinical skill for the advanced ophthalmic nurse (this is not intended to be an exhaustive list)

8


Outpatient department: competent nurse

Level Competence Performance criteria Knowledge and understanding Contextual factors

1 Demonstrates technicalskills in the assessment ofvisual acuity.

Demonstrates ability to assessand record vision accuratelyusing a variety of assessmentmethods: • distance visual acuity • near vision tests • Amsler grid assessment• colour testing.

Vision, visual and pupillary pathways.

Appropriate conditions for testing vision.

Accurate observation and documentationof findings.

Uses findings to influence subsequentcare.

LogMAR.

Snellens charts.

RNIB.

Delivers care in a suitableenvironment to maintainpatient privacy, dignityand safety.

Displays timely preparation of aclean and suitableenvironment, andcommunicates fully with thepatient to enable theappropriate care to beundertaken.

Effective communication.

Controlling an environment conducive todelivering quality care.

Relevant tests and investigations, egtesting for RAPD (Relative AfferentPupillary Defect) patient assessment.

Eye drop instillation.

Is able to adapt the environment to theneeds of the visually impaired or blindperson.

Health, safety anddignity policies.

Laser safety.

Team working.

Applies appropriate legal,ethical and professionalrequirements in theophthalmic outpatientdepartment.

Expresses an understanding ofthe importance of: consent, useof patient group directions,patient specific directions andthe law relating to ophthalmicmedications when preparingpatients for examination.

Anti-discrimination legislation andreporting.

Equality and diversity.

Human rights.

Implications of clinical negligence.

Health and safety.

Infection control.

Managing risk.

Is able to adapt skills to the needs of thevisually impaired or blind person.

Safeguardingvulnerable adults.

Mental capacity.

Policy guidance.

Selects appropriatecommunication strategiesto assess/record patientophthalmic and generalhistory.

Accurately records a patient’smedical, ophthalmic, family andpsychosocial history throughefficient communicationenquiry skills, in order to elicitthe patient’s background.

Effective communication skillswhich enable patients tounderstand and consent to anyexaminations or interventionsthat may be required.

Cultural and socio-cultural aspects ofcare.

Knowledge of legislation and policyrelating to documentation andconfidentiality/record keeping.

Excellent communication skills (writtenand oral).

Data Protection Act.

Equality and diversitymatters.

Complaints and issuepolicies.

Privacy and dignity.

Disability/low visionissues.

Delivers appropriatepatient information in amanner that is sensitive totheir condition and abilityto understand.

Demonstrates the use of avariety of communicationmethods to provide informationthat assists patients/carers intheir understanding of their eyecondition.

Good communication practice.

Low vision awareness.

Understanding of learning, hearing andlanguage difficulties.

Limits in the realm of the sphere ofresponsibility.

Informationsources/resources.

Informationtechnology.

Outpatient department


9

Outpatient department: competent nurse


1 Plans and organises thedelivery of care for anidentified ophthalmicpatient group.

Delivers planned ophthalmiccare in each clinic session.

Ensures the necessaryresources and skill mix isavailable to meet a patient’sneeds in a timely manner.

Prepares patients for a range ofophthalmic examinations andinterventions, utilising holisticprinciples.

Management of an outpatient clinic.

Resource allocation.

Prioritising care/tests and investigations.

Awareness of limits of sphere ofresponsibility.

Liaising with others to facilitate/expeditepatient care.

The productivedepartment.

Up-to-dateknowledge of relevanthospital policies.

Assesses and monitorspractice to ensureoptimum patient safetyduring clinical interaction.

Monitors patients, recognisescomplications followingspecialist investigations ortreatment and reacts effectivelyto a patient’s clinical needs.

Knowledge of all relevant safety aspectsof equipment used.

Risk assessment and risk managementawareness.

Understands the need for environmentalmonitoring, especially when dealingwith people with vision impairment andor other communication/mobility needs.

Manufacturer’sequipmentguidelines.

Trust training.

Accident and incidentreporting.

COSHH.

Infection control.

10


Outpatient department: specialist ophthalmic nurse


2 Functions autonomouslyand within the team todeliver health outcomeswithin a qualityframework.

An in-depth knowledge ofophthalmic care and drawsupon wide experience andpractical skill to deliver thehighest standard of care.

Demonstrates an ability to workautonomously, managing the outpatientepisode of consultation, investigation andtreatment within protocols and guidelines.

Regularly applies skills and evidence-basedknowledge to day-to-day practice to deliverquality care.

Able to troubleshoot problems with technicalequipment.

Has an in-depth knowledge of local, nationaland international policy and procedure inrelation to practice.


Ophthalmic course.

Brilliant Basics –quality campaign.


Demonstrates exceptionalleadership qualities thatempowers others todeliver the best care,whilst recognising ownlimitations and need toenhance knowledge andskills.

Involved in clinical supervision andmentorship of junior staff.

Contributes to the evidence base within theoutpatient environment.

Demonstrates an ability to coordinate and runthe department, and manage the day-to-dayrunning of the department.


Mentorship.


Demonstrates an in-depthunderstanding of ownclinical knowledge andability and that of others inthe team.

Provides care at an operational and strategiclevel.

Undertakes, and is involved with, clinicalaudit and research.

Demonstrates an awareness of the mechanicsof safe ophthalmic practice in relation toophthalmic care.

Clinical audit.

Able to use highlydeveloped communicationskills in complexsituations with bothophthalmic patients,carers and internal andexternal personnel.

Able to use complexstrategies to deal withcommunication issuessuch as breaking badnews.

Demonstrates ability to direct patients andcarers to appropriate agencies andinformation sources.

Demonstrates ability to access patientsupport services rapidly and appropriately,using tools such as registration.

Documents relating tocertification andreferral of visualimpairment.

Manages own patientcaseload and works as theresponsible clinician inmultidisciplinary andher/his own clinicsessions.

Has a high level ofophthalmic skills andknowledge relating to aparticular patient group.

Has autonomous practiceskills.

Acts as a resource to otherclinicians.

Advanced ophthalmic anatomy andphysiology, pathophysiology andmanagement/pharmacology.

Nursing theory.

Consultation models.

Ophthalmic clinical examination/slit lampskills.

Advanced slit lamp examination skills andclinical decision making.

Non-medicalprescribing.


11

Outpatient department: specialist ophthalmic nurse


2 Applies effectiveleadership andsupervisory skills tosupport servicedevelopment andinnovation.

Demonstrates exceptionalleadership andsupervisory skills.

Demonstrates an exceptional level ofcommunication.

Understands own personal limitations andtakes steps to fill gaps in knowledge and skills.

Undertakes a supervisory role in thedevelopment of junior staff and teaches andsupervises as required.

Supports the service requirements andrecognises potential for innovation andimprovement of services.

Audit.



Demonstrates a clearability to provide anexcellent environment forclinical learning, supportand development withinthe theatre(anaesthetics/scrub/recovery) context.

Provides knowledge of the needs of thoserequiring support and provides a suitablelevel of clinical support.

Able to understand the learning needs ofothers in the environment, especially on newtechniques and equipment.

Mentorship.

12


Outpatient department: advanced ophthalmic nurse


3 Uses theoreticalframeworks for clinicaldecision making anddiagnostic reasoning.

Demonstrates use ofconsultation models inpractice.

Demonstrates skilledprotocol development andreview.


Prescribing models.

Non-medicalprescribingqualification.


Demonstrates a complexmultifaceted approach topractice, incorporatingindividual professionaland organisationalinfluences.

History of the development of advanced rolesin nursing and impact on current practice.

Demonstrates an in-depth understanding oflocal and national policy, guidance andlegislation that guides practice.

Demonstrates an expert knowledge ofcollaborative practice and the impact onservice provision in line with patient care.

Understands the impact of governmentalinitiatives in health care generally on(advanced) nursing practice.

Legal and professional underpinnings ofadvanced practice.

Demonstrates expert leadership qualities thatdefine care and quality, and that sets anexample to others.

Societal influences –easy availability ofinformation.


Demonstrates professionalbehaviour at all times,which is in keeping withprofessional accountabilityon all areas of clinicaldecision making andoverall patient care.

Acts as a role model.

Acts as expert witness orconsultant both inside andoutside the ophthalmicsetting.

Demonstrates an ability to appreciate ownlimitations and critically evaluates ownpractice.

Expert understanding of the scope of ownclinical practice and is able to define thelimits of responsibility and accountability.

Demonstrates a clear awareness andunderstanding of legal aspects of care.


Learningopportunities.

Clinical supervision.


Participates in clinicalgovernance.

Instigates auditdissemination and appliesresults to practice.

Appreciates the impact ofclinical research and auditto improve serviceprovision.

Clinical governance framework.

Demonstrates a wider expert knowledge ofservice frameworks and the trust’s long-termplan.

Demonstrates an appreciation of innovationand improvements of service that impactpositively on patient care – including researchand audit.

Local qualityprocesses.

Clinical audit.

Clinical research.

Critical reflection inand on practice.



13

Ophthalmic theatre: competent nurse


1 Adopts a critical approachto ophthalmic carethrough reflection onpractice.

Provides evidence ofreflective thinking on theday-to-day care of the peri-operative patient. Keeps areflective diary anddiscusses with mentor.

Skills and knowledge arerecorded in a medicalappliance inventory and isupdated annually.

Recognises own personal limitations andabilities, considers personal development planto address gaps in knowledge.

Evidence and guidance from national and localpolicy.

Recognises good practice, but challengesinappropriate practice.

Escalation policy.

Awareness of particular theatre equipment,how they work and troubleshooting.

Knowledge and skillsframework.

Theatre scrub skills.

Anaesthetic andrecovery practice.

Applies understanding ofthe physiological,pathological,psychosocial,pharmacological andcultural to meet thepatient’s needs.

Provides the careappropriate to reflect theneeds of the pre-, peri- andpost-operative patient.

Contextually appliesunderstanding in relationto the specific individualrole within theatre.

Understanding of ophthalmic patient careneeds in the theatre setting – particularlysensory deprivation.

Demonstrates good understanding of:

• the physiology of the eye and surroundingadnexa and can apply to theatre practice• the cultural needs of the patient withinthe theatre setting• ophthalmic and general pharmacology.

Safeguarding.

Dignity and respect.

Integrated carepathways.

Health and safety.

Cultural policy andawareness.

Selects appropriatestrategies for assessing,planning, implementingand evaluating the care ofthe client group.

Evaluates, applies andmaintains models ofnursing and pathways ofcare throughout theophthalmic patient journeythrough theatre.

Demonstrates a working knowledge of thenursing process in relation to peri-operativepractice.

Able to synthesise a working knowledge ofophthalmic surgery when assessing, planningand implementing care.

Demonstrates a good level of communicationthat is consistent with the level ofunderstanding.

Evidence-based care.

Knowledge of use andcare ofinstrumentation.

Applies appropriate legal,ethical and professionalrequirements to thedelivery of care.

Awareness of legal andprofessional issues inrelation to ophthalmictheatre practice.

Understands and contributes to the WHOchecklist.

Has a good understanding of the legalperspective in relation to consent and theatrepractice.

Awareness of responsibility andaccountability in relation to scrub andanaesthetic support roles.

Consent.

WHO checklist.

Job specification.

NMC guidance andscope.

Adopts and employsappropriate strategies toprovide a safeenvironment.

Demonstrates knowledgeof the importance ofmaintaining a safe andsuitable environment forpatients and colleagues inthe theatre area, andparticularly for theunconscious patient.

Knowledge of the ophthalmic theatreenvironment including: layout, ventilation,microscopes, medical gas supply, theatreequipment and the anaesthetic machine.

Awareness of the fundamental physiology ofhow anaesthetic affects patients.

Awareness of policy and protocol in relationto health and safety.

COSHH

Moving and handling.

Laser safety.

Infection control.

Emergency care.

Works effectively andefficiently with membersof the interdisciplinaryteam (IDT).

Demonstrates aknowledge of themechanism by which theIDT working effects thecare of patients in thetheatre setting.

Able to discuss the interrelationship of theIDT and how this impacts on patient care inthe theatre setting.

Contributes to the improvement of serviceprovision in the theatre setting.

Preceptorship.

(These competences are intended to supplement core theatre skills

Ophthalmic theatre

14


Ophthalmic theatre: competent nurse


1 Delivers care that issensitive to the patient’sneeds in the context oftheir multicultural anddynamic society.

Supports and meets thepatient’s cultural, privacyand dignity requirementswhilst in theatre.

Knowledge of specific cultural requirements ofthe patient whilst in theatre.

Applies a working knowledge of the need tosupport the patient’s privacy and dignity at alltimes whilst in theatre.

Local privacy anddignity policy.

Delivers care appropriateto the needs of thoseexperiencing loss andgrief, and managing theirongoing psycho-socialneed.

Demonstrates anunderstanding of loss andgrief in the ophthalmicpatient – loss of an eye orsight, and thepsychological effect of thison the patient andrelatives.

Understands the process of loss and grief andcan apply this to the enucleated, exenterated,traumatised patient or in relation toblindness.

Psychological aspectsof caring.

Spiritual care needs.

Religious and culturallegislation andpolicies.

(These competences are intended to supplement core theatre skills


15

Ophthalmic theatre: specialist ophthalmic nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

2 Functions autonomouslyand within the theatreteam to deliver healthoutcomes, within a qualityframework.

An in-depth knowledge ofophthalmic theatre careand draws upon wideexperience and practicalskill to deliver the higheststandard of care.

Demonstrates an exceptional knowledge oftheatre skills (eg scrub and/or anaesthetic) inrelation to ophthalmic theatre practice andbeyond.

Regularly applies skills and evidence-basedknowledge to day-to-day practice to deliverquality care.

Demonstrates advanced elements of firstassistant practice that is applied separately toscrub role.

Able to troubleshoot problems with technicalequipment.

Has an in-depth knowledge of local, nationaland international policy and procedure inrelation to practice.


Ophthalmic course.

Brilliant basics –quality campaign.


Demonstrates exceptionalleadership qualities thatempowers others todeliver the best care,whilst recognising ownlimitations and need toenhance knowledge andskills.


Contributes to the evidence base within thetheatre environment.

Demonstrates an ability to coordinate and runa theatre (department) and manage the day-to-day running of the department.


Mentorship.


Demonstrates an in-depthunderstanding of ownclinical ability and that ofothers in the theatre team.

Provides care at an operational and strategiclevel.

Undertakes and is involved with clinical auditand research.

Demonstrates an awareness of the mechanicsof safe theatre practice in relation toophthalmic care and is aware of theescalation policy.

Clinical audit.

Applies effectiveleadership andsupervisory skills tosupport servicedevelopment andinnovation.

Demonstrates exceptionalleadership andsupervisory skills.


Understands own personal limitations andtakes steps to fill gaps in knowledge andskills.

Undertakes a supervisory role in thedevelopment of junior theatre staff in relationto the scrub and anaesthetic role.

Supports the theatre service requirementsand recognises potential for innovation andimprovement of services.

Audit.



Demonstrates a clearability to provide anexcellent environment forclinical learning, supportand development withinthe theatre context(anaesthetics/scrub/recovery).

Provides knowledge of the needs of thoserequiring support and provides a suitablelevel of clinical support.

Able to understand the learning needs ofothers in the theatre environment, especiallyany new techniques and equipment.

Mentorship.

16


Ophthalmic theatre: advanced ophthalmic nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

3 Uses theoreticalframeworks for clinicaldecision making anddiagnostic reasoning.

Demonstrates an ability towork autonomously and isable to synthesise andcollaborate theoreticalframeworks to providequality care for ophthalmictheatre patients.

Demonstrates an expert knowledge ofophthalmic care, of which surgery is anelement of the care.

Demonstrates an advanced ability to predictnecessary care and anticipate clinical needs ofpatients in the theatre environment.

Has a clearly defined understanding of thedecision making process and is able todemonstrate an ability to use this in anysituation.

Critical analysis ofown practice throughreflection and peerreview.

Research evidenceinforms practice.

Clinical guidelines,local and national(NICE).


An expert understandingof local, national andinternational policy,procedure and guidanceon issues that impact upontheatre care.

Able to work within theconfines of the IDT, andmay use clinical expertiseand collaboration to guideclinical practice.

Develops own practice toinclude more expandedroles, such as performingminor surgery.

Is able to demonstrate an in-depthunderstanding of local and national policy,guidance and legislation that guides practice.

Demonstrates expert knowledge ofcollaborative practice and the impact onservice provision in line with patient care.

Demonstrates expert leadership qualities thatdefine care and quality, and that sets anexample to others.

Critical reflection onpractice.

Professionaldevelopment.

Personaldevelopmentreviews/involvementin appraisal.

Maintains a personalprofile.


Self awareness of ownresponsibility andaccountability in relationto own clinical ability andthat of others.



Demonstrates a clear awareness andunderstanding of legal aspects of theatrecare.





Teaching andlearning.


Appreciates the impact ofclinical research and auditto improve serviceprovision.

Demonstrates a wider expert knowledge ofservice frameworks and the trust’s long-termplan.

Demonstrates an appreciation of innovationand improvements of service that impactpositively on patient care – including researchand audit.

Clinical audit.

Clinical research.




17

Inpatient settings: competent and specialist nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

1 Works with thepatient todevelop theirunderstandingof theircondition andtreatment.

Asks questions and actively listens.

Establishes the patient’s preferences andboundaries for sharing personal healthinformation, ie protecting their privacy andconfidentiality.

Co-develops, implements and evaluates apersonal care plan/pathway, treating thepatient as an individual not as a groupmember.

Explains care/treatment options and offerschoices to reach joint and informed decisions.

Records an agreed plan of care and thepatient’s own role and expertise in their care.

Invites the patient to share their experienceas a resource for teaching nurses and others.

Works with the patient in the creation of anindividual care plan, co-ordinates care andensures that the care delivered is of a highstandard and provides local guidance.

Knowledge of use of open andclosed questions.

Knowledge of the normal and alteredanatomy and physiology.

Understands treatment/care optionsand their risks/benefits.

Understands the patient as a personand their life outside of the hospital.

Maturity – to be able to separategeneral knowledge of the conditionfrom the person’s own history.

Patient Safety Firstcampaign:www.patientsafetyfirst.nhs.uk

Patient-centred policydocuments.

Data Protection Act.

National occupationalstandards for healthand social care HSC31and HSC35.

Standards andguidelines onmanaging ophthalmicconditions andtreatments.

Making time to care.

RCO guidelines, NICEguidance, NHS library.

Inpatient settings: competent and specialist nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

2 Assesses thepatient’s needsin collaborationwith the patientand in line withthe relevant carepathway.

Explains issues that may arise duringassessment. Explores the patient’s currentlifestyle, hopes and expectations as part ofdischarge planning. Assesses the patient’scultural/family background and identifiespersonal preferences.

Explores the impact of the patient’s conditionwith regard to their cultural background andlife choices, eg reproductive choices.

Co-ordinates the activities of staff during ashift.

Provides more in-depth knowledge and skillwhen caring for patients with acute andchronic ocular conditions.

Teaches and supervises staff and patients.

Uses specialist knowledge to recognise andreport deviations from expected progress ofthe acute or chronically ill patient.

Understands the implications ofimplementing policies/procedures.

Understands different cultures andfaiths, and the potential impact ofthese upon the patient’s personalbeliefs and viewpoints.

Knowledge of the range of resources,information and support to which thepatient can be referred.

Uses specialist knowledge torecognise and report deviations fromexpected progress of the pre- andpost-operative patient.

Draws on specialist knowledge andskill to instigate emergencytreatments as appropriate.

Adult early warningscore.

Falls Riskassessment.

MUST assessment.

Inpatient settings

18


Inpatient settings: advanced ophthalmic nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

3 Uses theoreticalframeworks forclinical decisionmaking anddiagnosticreasoning.

Demonstrates use of consultation modelsin practice.

Demonstrates skilled protocoldevelopment and review.

Explores/researches therationale/evidence base for specificophthalmic care interventions.

Prioritises care needs in response tochanges.


Prescribing models.

Current research.


NICE guidance.

Analysesindividual,professional andorganisational(local andnational)influences onleadership andcollaborativepractice.

Demonstrates a complex multifacetedapproach to practice, incorporatingindividual, professional andorganisational influences.

Monitors and evaluates policies andprotocols.

History of the development of advancedroles in nursing and impact on currentpractice.

Demonstrates an in-depth understandingof local and national policy, guidance andlegislation that guides practice, especiallyin the wider emergency care sector.


Impact of governmental initiatives inhealth care generally on (advanced)nursing practice.

Legal and professional underpinnings ofadvanced practice.

Demonstrates expert leadership qualitiesthat define care and quality, and that setsan example to others.


Exercisesprofessionalaccountability inrelation todeveloping selfand others.

Demonstrates professional behaviour atall times, in keeping with professionalaccountability on clinical decision makingand overall patient care.

Role model.

Acts as expert witness or consultantinside and outside the ophthalmicsetting.







Uses qualityframeworks toevaluate anddevelop practiceand serviceprovision.

Appreciates the impact of clinicalresearch and audit to improve serviceprovision.

Demonstrates a wider expert knowledgeof service frameworks and the trust’slong-term plan.

Demonstrates an appreciation ofinnovation and improvements of servicethat impact positively on patient care –including research and audit.

Clinical audit.

Clinical research.




19

Ambulatory care/day case: competent nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

1 Adopts a criticalapproach toophthalmic carethroughreflection onpractice.

Provides evidence of reflective thinking inthe light of the day-to-day care of pre-andpost-operative patients.

Keeps a reflective diary and discusseswith mentor.

Skills and knowledge are recorded in amedical appliance infantry and isupdated annually.

Recognises own personal limitations andabilities, considers personal developmentplan to address gaps in knowledge.

Evidence and guidance from national andlocal policy.

Recognises good practice, but challengesinappropriate practice.

Escalation policy.

Awareness of biometry and keratometryequipment, understand the dynamics ofbiometry and troubleshooting.

Knowledge and skillsframework.

Applies theirunderstandingof thephysiological,pathological,psychosocial,pharmacologicaland cultural tomeet patientneeds.

Provides care appropriate to reflect theneeds of the pre-, peri- and post-operative patient.

Contextually applies understanding inrelation to specific individual role withinthe ambulatory care setting.

Understanding of ophthalmic patient careneeds in the ambulatory care setting,especially in relation to sensorydeprivation.

Good understanding of the physiology ofthe eye and surrounding adnexa, and isable to apply to theatre practice.

Good understanding of the cultural needsof the patient within the ambulatory caresetting.

Demonstrates a good understanding ofophthalmic and general pharmacology.

Safeguarding.


Integrated carepathways.

Health and Safety.

Cultural policy andawareness.

Selectsappropriatestrategies forassessing,planning,implementingand evaluatingthe care of theclient group.

Evaluates, applies and maintains modelsof nursing and pathways of carethroughout the ophthalmic patient,through the ambulatory care setting.

Demonstrates a working knowledge of thenursing process in pre- and post-operativepractice.

Able to synthesise a working knowledgeof ophthalmic ambulatory care whenassessing, planning and implementingcare.

Considers the application of integratedcare plans.

Demonstrates a good level ofcommunication that is consistent with thelevel of understanding.

Demonstrates a good understanding ofthe pre-assessment practitioner role andworks within defined parameters.

Appliesappropriatelegal, ethicaland professionalrequirements tothe delivery ofcare.

Awareness of legal and professionalissues of ophthalmic ambulatory carepractice.

Has a good understanding of the legalperspective in relation to consent.

Awareness of responsibility andaccountability of the practitioner’s rolewithin the ambulatory day case setting.

Consent.

KSF job specification.

NMC guidance andscope.

Ambulatory care/day case

20


Ambulatory care/day case: competent nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

1 Adopts andemploysappropriatestrategies toprovide a safeenvironment.

Demonstrates knowledge of theimportance of maintaining a safe andsuitable environment for patients andcolleagues in the day care and pre-assessment setting.

Awareness of ophthalmic surgicalprocedures and the subsequent pre- andpost-operative care.

Awareness of the fundamental physiologyof how anaesthetic affects patients, and isable to demonstrate the ability to care forpost-operative patients.

Awareness of local and national policyand protocols on health and safety.

Adult early warning score.

Falls risk assessment.

MUST assessment.

Workseffectively andefficiently withmembers of theinterdisciplinaryteam (IDT).

Demonstrates a knowledge of themechanism by which the IDT workingeffects the care of patients in theambulatory care setting.

Able to discuss the interrelationship of theIDT and how this impacts on patient carein the day case/pre-assessment setting.

Contributes to the improvement of localservice provision in the ambulatory caresetting and considers the impact andimportance of national governmentalstrategic policy in regard to this.

NHS institution.

NHS prescribing.

Local policies.

Delivers carethat is sensitiveto the patient’sneeds in thecontext of theirmulticulturaland dynamicsociety.

Supports and meets the patient’scultural, privacy and dignity requirementswhilst in the ambulatory care setting.

Knowledge of specific culturalrequirements of the patient whilst in daycase/pre-assessment.

Applies a working knowledge of the needto support the patient’s privacy anddignity at all times whilst in day case/pre-assessment setting.

Local privacy anddignity policy.

Organises andjustifies care,appropriate tothe needs ofthoseexperiencingloss and grief,and managingtheir ongoingpsycho-socialneed.

Demonstrates an understanding of lossand grief in the ophthalmic patient – lossof an eye or sight, and the psychologicaleffect of this on the patient and relatives.

Understands the process of loss and griefand can apply this to the enucleated,exenterated, traumatised patient or inrelation to blindness.


21

Ambulatory care/day case: specialist ophthalmic nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors

2 Functionsautonomouslyand within theambulatory caresetting to deliverhealth outcomeswithin a qualityframework.

An in-depth knowledge of ophthalmicambulatory care.

Draws upon wide experience andpractical skill to deliver the higheststandard of care within day case and pre-assessment.

Troubleshoots problems with technicalequipment.

Demonstrates an exceptional knowledgeof ophthalmic ambulatory, pre-, peri- andpost operative care.

Regularly applies skills and evidence-based knowledge to day-to-day practiceto deliver quality care.

Demonstrates an ability to consider theimplications of specific diagnostic testsand adopts care appropriately.

In-depth knowledge of local, national andinternational policy and procedure inrelation to practice.


Ophthalmic course.

Brilliant Basics –Quality campaign.

Empowersothers to deliverevidence-basedcare whilstdeveloping theirown practice.

Demonstrates exceptional leadershipqualities that empowers others to deliverthe best care, whilst also recognising ownlimitations and the need to enhanceknowledge and skills.


Coordinates and manages the daycase/pre-assessment department.

Contributes to the evidence base withinthe ambulatory care environment.


Mentorship.

Manages andevaluatesclinical practiceto ensure safe,evidence-basedophthalmic care.

Demonstrates an in-depth understandingof own clinical ability and that of others inthe ambulatory team.

Undertakes and is involved with clinicalaudit and research.

Provides care at an operational,divisional and strategic level.

Awareness of the mechanics of safepractice in relation to ophthalmic care andis aware of the escalation policy.

Clinical audit.

Applies effectiveleadership andsupervisoryskills to supportservicedevelopmentand innovation.

Demonstrates exceptional leadership andsupervisory skills.


Undertakes a supervisory role in thedevelopment of junior theatre staff inrelation to the role.

Supports the theatre servicerequirements and recognises potentialfor innovation and improvement ofservices.

Understands own personal limitationsand takes steps to fill gaps in knowledgeand skills.

Activelycontributes tothe developmentandmaintenance ofan effectiveclinical learningenvironment.

Provides an excellent environment forclinical learning, support anddevelopment .

Identifies the needs of those requiringsupport and provides a suitable level ofclinical support.

Understands the learning needs of othersin the ambulatory care environmentespecially for new techniques andequipment.

22


Ambulatory care/day case: advanced ophthalmic nurseLevel Competence Performance criteria Knowledge and understanding Contextual factors


Demonstrates an ability to workautonomously and is able to synthesiseand collaborate theoretical frameworksto provide quality care for ophthalmic daycase patients.

Demonstrates an expert knowledge ofophthalmic care, of which surgery is anelement of the care.

Demonstrates an advanced ability topredict necessary care and anticipate theclinical needs of patients in the day caseand pre-assessment environment.

Has a clearly defined understanding of thedecision making process and is able todemonstrate an ability to use this in anysituation.



Clinical guidelines,local and national forexample NICEguidelines.


An expert understanding of local,national and international policy,procedure and guidance on issues thatimpact upon patient care.

Works within the confines of the IDT andmay use clinical expertise andcollaboration to guide clinical practice.

Demonstrates an in-depth understandingof local and national policy, guidance andlegislation that guides practice.


Demonstrates expert leadership qualitiesthat define care and quality, and that setsan example to others.




Exercisesprofessionalaccountabilitywhendeveloping selfand others.

Self awareness of own responsibility andaccountability in relation to own clinicalability and that of others.



Demonstrates a clear awareness andunderstanding of legal aspects ofambulatory care.








Appreciates the impact of clinicalresearch and audit to improve serviceprovision.

Demonstrates a wider expert knowledgeof service frameworks and the divisional,national, governmental plan.

Demonstrates an appreciation ofinnovation and improvements of servicethat impact positively on patient care –including research and audit.

Clinical audit.

Clinical research.



23

Children and young people: competent nurse


1 Adopts a criticalapproach toophthalmic carethroughreflection onpractice.

Delivers care with consideration andtakes into account the possiblepsychological consequences forindividual children and their families ofsight loss.

Understand the psychological andphysical consequences for the child ofparental separation.

Develops knowledge of the possiblepsychological effects of an eye conditionon a child.

Demonstrates knowledge of thepsychological effects of hospitalisation onchildren and their families.

Family-centred care.

Portfolio building.

Applies theirunderstandingof the paediatricphysiological,pathological,psychosocial,pharmologicaland cultural tomeet patientneeds.

Provides care appropriate for thedevelopment stage of the child/youngperson.

Communicates effectively with the youngperson and their family.

Develops knowledge of the possiblepsychological effects of an eye conditionon a child.

Demonstrates knowledge of thepsychological effects of hospitalisation onchildren and their families.


Care pathways.

Infection control.

Selectsappropriatestrategies forassessing,planning,implementingand evaluatingthe care of theclient group.

Evaluates models of nursing andpathways of care.

Communicates effectively with the youngperson and their parents and siblings.

Uses appropriate play strategies.

Delivers care to meet the specific needsof children undergoing pre- and post-operative ophthalmic surgery.

Uses knowledge to identify, improve andreport actual and potential risks tochildren.

Health promotion models.

Disease prevention.

Demonstrates knowledge of particularrisks faced by children with impairedvision.

Understands the child developmentmilestones and the level of integrationthat is required at each stage.

Understands the vital signs for children,recognises and responds appropriately tothe sick child.

Uses Paediatric Early Warning Score.

Models of care.

Care pathways.

Relevant policies andprocedures.

Appliesappropriatelegal, ethicaland professionalrequirements tothe delivery ofcare.

Performs care for the child or youngperson based on best practice guidanceand legal requirements.

Consent is applied to children and youngpeople.

Confidentiality.

Best interests of the child.

NSF children.

Adopts andemploysappropriatestrategies toprovide a safeenvironment.

Demonstrates knowledge of theimportance of maintaining a safe andsuitable environment for children.

Understands the mechanisms whichresult in different physiologicalresponses by children to: illness/trauma,sedation, anaesthesia.

Child protection.

Knowledge of risk assessment.

Recognition and response when a child isin need.

Recognition of indicators of child abuseand family risk factors.

Knowledge of appropriate response whena child requires protection, within thecontext of safeguarding regulations.

Safeguarding.

(see also – Core competences for nursing children and young people (RCN, 2012))

Children and young people

24


Children and young people: competent nurse


1 Workseffectively andefficiently withmembers of theinterdisciplinaryteam.

Working within the team but also withother agencies.

Understands the roles (andresponsibilities) of the multidisciplinaryteam and assesses/referralarrangements.

NHS institution.

NHS prescribing.

Local policies.

Delivers carethat is sensitiveto the patient’sneeds in thecontext of theirmulticulturaland dynamicsociety.

Supports and meets the youngperson’s/parental cultural needs.

Understands requirements of children atdifferent developmental stages.

Understands the different cultural andsocietal needs of both the child and therefamily group.

Equality and diversitylegislation and localpolicies.

Disabilitydiscriminationlegislation.

Organises andjustifies careappropriate tothe needs ofthoseexperiencingloss and grief,and managestheir ongoingpsycho-socialneed.

Demonstrates knowledge of childhoodgrief and loss and applies this within thecontext of normal child development.

Understands the process of loss and griefand can apply this to parental guilt.

Understands bereavement and grief inchildren.

(see also – Core competences for nursing children and young people (RCN, 2012))


25

Children and young people: specialist ophthalmic nurse


2 Functionsautonomouslyto deliver healthoutcomes withina qualityframework.

Consistently demonstratestechniques of effectivecommunication with childrenalong the developmentalcontinuum (with a variety ofhealth needs).

Understands the possibleconsequences of delayeddevelopment.

Undertakes assessment of achild’s needs, and plans care tomeet these needs.

Social theories to understand ways in whichmodern families are constituted; uses thisknowledge to establish effective two-waycommunications.


Acts as a resource for others andprovides evidence-based care.


Draws upon specific children’s nursing theories todevelop good relationships with children andfamilies, focusing on family-centred care andworking in partnership with children and theirfamilies.

Parents as carers.

Uses knowledge of attachment and separationtheories to work with child and family to minimisethe detrimental effects of the hospital environmenton the child’s wellbeing.

Manages andevaluatesclinical practiceto ensure safe,evidence-basedcare.

Uses baseline knowledge torecognise and report deviationsin expected child ophthalmicand visual development.

Practise care at an operational and strategic level.

Aware of the rights of minors who have reached theage of 16 to consent to, and refuse to take part in,research trials.

Knowledge of the principles of parallel consent;minors who have reached the age of 16 and theirparents.

Applies Gillick competency/Fraser guidelines withconsenting children and young people.

Knows the rights of the person who does not haveparental responsibility for a child, but does havecare of the child.

Audit.

Consent applied tochildren.

Gillick competencyand Fraser guidelines.

Demonstrateseffectiveleadership andsupervisoryskills to supportservicedevelopmentand innovation.

For serious eye conditions, usesnursing knowledge to foster thedevelopment of specific copingstrategies for children, theirfamilies and their friends.

Demonstrates and teaches from a wide knowledgebase/experience how to manage children who areunder physiological stress.


Works collaboratively andteaches others as part of themultidisciplinary team.

Meets the needs of a group ofchildren and parents, whilst atthe same time dealing with asick child in an emergencysituation.

Knowledge of services available for visuallyimpaired children and their families.

Understands different learning styles and how toconvey information though these.

Applies principles of family-centred care whenteaching the child and family.

26


Children and young people: advanced ophthalmic nurse



Able to offer advice andknowledge to nursing andmedical staff emanating frompersonal, practical experienceon issues relating to consent(including a clash of viewsinvolving consent betweenparent and child).

Communicates effectively with children and familiesin challenging situations.

Knowledge of the circumstances under which achild can give valid consent.

Gillickcompetency/Fraserguidelines.



Clinical guidelines,local and national(NICE).


Develops commissioning andservice delivery plans.

Plans and provides servicesaccordingly.

Use theoretical knowledge and professionalexperience to actively plan the environment andadapt systems to meet the needs of children andfamilies.

Understands the commissioning process.





Designs and implementspolicies to meet professionaland statutory regulations.

Reviews others work onregulation.

Critical use of professional and statutoryregulations.






Audits children’s services.

Works with families, groups offamilies and other agencies toensure that a child’s maximumindividual development isreached.

Demonstrates a wider expert knowledge of serviceframeworks and the divisional, national,governmental plan.

Demonstrates an appreciation of innovation andimprovements of service that impact positively onpatient care – including research and audit.

Clinical audit.

Clinical research.



27

Emergency department: specialist ophthalmic nurse


2 Functionsautonomouslyto deliver healthoutcomes,within a qualityframework.

Demonstrates ability toautonomously triage andprioritise/redirect ophthalmicemergency patientsappropriately.

Demonstrates the ability toassess, diagnose and manage orrefer undifferentiated andundiagnosed ophthalmicconditions or injuries.

Advanced ophthalmic anatomy and physiology,pathophysiology and management/pharmacology.

Nursing theory.


Ophthalmic clinical examination/slit lamp skills.

Advanced slit lamp examination skills and clinicaldecision making

Non-medicalprescribing.


Participation in the developmentof protocols to guide practice.

Demonstrates provision ofclinical supervision andcompetency assessment.

Demonstrates ongoingmaintenance of current practicethrough knowledge andapplication of current evidence.

Updates and maintains NMCmentor status.

Understands protocol development and localpolicy.

Educational theory.

Research processes and able to critique quality ofevidence.

Mentorship skills.

Recorded mentorship.

Manages andevaluatesclinical practiceto ensure safe,evidence-basedcare.

Instigates and participates inclinical audit and review.

Participates in clinical research.

The research process.

In-depth knowledge of ophthalmology.

Collaboration withhospital researchdepartment.

Demonstrateseffectiveleadership andsupervisoryskills to supportservicedevelopmentand innovation.

Takes responsibility for leadingthe team with the ability toprescribe, initiate and monitorthe immediate care of patientswith undifferentiated andundiagnosed ophthalmicconditions or injuries.

Behaves as a resource and rolemodel for junior nurses,students and other health careprofessionals.

Participates in mentorship andclinical supervision.

Maintains and applies topractice an up-to-date evidence-based knowledge base.

Educational theory.

Mentorship skills.

Management and leadership knowledge and skills.

Collaboration with themultidisciplinaryteam.


Participates in the developmentof local teaching/learningpackages.

Participates in ensuring that theteam maintains up-to-datementorship skills by attendingupdates and maintaining theirknowledge base.

Fosters a departmentalopenness to learning andteaching.

Teaching and learning theory.

(Refer to OPD level 1 for competent nurse in an emergency setting)

Emergency department

28


Emergency department: advanced ophthalmic nurse



Demonstrates use ofconsultation models in practice.

Demonstrates skilled protocoldevelopment and review.


Prescribing models.



Demonstrates a complexmultifaceted approach topractice, incorporatingindividual, professional andorganisational influences.

History of the development of advanced roles innursing and impact on current practice.

Demonstrates an in-depth understanding of localand national policy, guidance and legislation thatguides practice – especially in relation to the wideremergency care sector.

Demonstrates an expert knowledge of collaborativepractice and the impact on service provision in linewith patient care.

Understands impact of governmental initiatives inhealth care on (advanced) nursing practice.

Understands legal and professional underpinningsof advanced practice.

Demonstrates expert leadership qualities thatdefine care and quality, and that sets an example toothers.



Demonstrates professionalbehaviour at all times which is inkeeping with professionalaccountability on decisionmaking and overall patient care.

Role model.

Acts as expert witness orconsultant inside and outsidethe ophthalmic setting.

Demonstrates an ability to appreciate ownlimitations and critically evaluates own practice.

Expert understanding of the scope of own clinicalpractice and is able to define the limits ofresponsibility and accountability.






Appreciates the impact ofclinical research and audit toimprove service provision.

Demonstrates a wider expert knowledge of serviceframeworks and the trust’s long-term plan.

Demonstrates an appreciation of innovation andimprovements of service that impact positively onpatient care – including research and audit.

Clinical audit.

Clinical research.




29

Benner P (1984) From novice to expert, excellence andpower in clinical nursing practice. Menlo Park: Addison-Wesley Publishing Company

NSPCC (2012) Gillick competency and Fraser guidelines.NSPCC fact sheet, [online] Available at:www.nspcc.org.uk/inform/research/questions/gillick_wda61289.html [Accessed 7 September 2012]

Nursing and Midwifery Council (2008) The code:Standards of conduct, performance and ethics for nursesand midwives. [pdf] London: NMC. Available at:www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf [Accessed 7 September 2012]

Royal College of Nursing (2009a) Integrated core careerand competence framework for registered nurses. [pdf]London: RCN. Available at:www.rcn.org.uk/__data/assets/pdf_file/0005/276449/003053.pdf [Accessed 7 September 2012]

Royal College of Nursing (2009b) Nature, scope and valueof ophthalmic nursing (third edition). [pdf] London: RCN.Available at:www.rcn.org.uk/__data/assets/pdf_file/0010/258490/003521.pdf [Accessed 7 September 2012]

Royal College of Nursing (2012) Core competences fornursing children and young people. [pdf] London: RCN.Available at:www.rcn.org.uk/__data/assets/pdf_file/0006/442887/004202.pdf [Accessed 7 September 2012]

Field D, Tillotson J, MacFarlane M (2009) The OphthalmicStudy Guide for nurses and health professionals. Kendal:M&K Publishing

Marsden J (2006) Ophthalmic practice. Oxford: Wiley

Marsden J (Ed) (2008) Evidence base for ophthalmicnursing practice. Oxford: Wiley

Ring L and Okoro M (2012) A handbook of ophthalmicnursing standards and procedures. Kendal: M&KPublishing

Shaw ME, Lee A, Stollery R (2010) Ophthalmic Nursing(4th Ed). Chichester: Wiley-Blackwell.

3

ReferencesFurther reading

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

October 2012

Review date 2015

RCN Onlinewww.rcn.org.uk

RCN Directwww.rcn.org.uk/direct0345 772 6100

Published by the Royal College of Nursing 20 Cavendish SquareLondon W1G 0RN

020 7409 3333

www.facebook.com/royalcollegeofnursingwww.youtube.com/rcnonlinewww.twitter.com/thercn

Publication code 004 350

ISBN 978-1-908782-26-7

Novartis UK Limited provided an educational

grant to support this publication, but had no

influence over the content.

Kindly sponsored by SD Healthcare Ltd