Critical Care Networks- National Nurse Leads Step 3

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Critical Care Networks- National Nurse Leads




Step 3
National Competency Framework for
           Adult Critical Care Nurses




     Step 3 Competencies
                              STEP THREE COMPETENCIES PAGE 2



Contents

All step 3 competencies have been designed to further develop the
expert core skills required to safely and professionally care for the
critically ill patient without any direction. You will need to consolidate
the skills and knowledge you have already attained and in addition to
giving rational for your practice you will need to provide the evidence
base for the care you deliver. Some competency statements may be
similar but the level at which you are assessed will differ. You are advised
to keep a record of any supportive evidence and reflective practice to
assist you during progress and assessment reviews.

It is anticipated that Step 3 Competencies will further aid your
development, and will form part of local academic programmes
delivered at Level 6 or 7.



Learning Contract                                                       Page 3

Step Three Competencies
 Respiratory System                                                     Page 4
 Cardiovascular System                                                  Page 6
 Renal System                                                           Page 9
 Gastrointestinal System                                                Page 12
 End of Life Care                                                       Page 13
 Inter & Intra Hospital Transfer                                        Page 15
 Rehabilitation                                                         Page 19
 Professionalism                                                        Page 20
 Leadership                                                             Page 20

Assessment and Development Records                                      Page 21

Abbreviations                                                           Page 27

Bibliography                                                            Page 28

Acknowledgements                                                        Page 29




Created for CC3N by Giraffics Limited > mike.giraffics@googlemail.com
                                      STEP THREE COMPETENCIES PAGE 3



Learning Contract
The following Learning Contract applies to the Individual Learner, Lead Assessor and Unit Manger and should be
completed before embarking on this competency development programme. It will provide the foundations for:
 Individual commitment to learning
 Commitment to continuing supervision and support
 Provision of time and opportunities to learn



LEARNERS RESPONSIBILITIES
As a learner I intent to:
 Take responsibility for my own development
 Form a productive working relationship with mentors and assessors
 Listen to colleagues, mentors and assessors advice and utilise coaching opportunities
 Use constructive criticism positively to inform my learning
 Meet with my Lead Assessor at least 3 monthly
 Adopt a number of learning strategies to assist in my development
 Put myself forward for learning opportunities as they arise
 Undertake Step 3 competencies during a formal critical care educational programme
 Use this competency development programme to inform my annual appraisal and development needs
 Report lack of supervision or support directly to unit manager at the first opportunity


Signature ...............................................................   Date: ...................................



LEAD ASSESSOR RESPONSIBILITIES
As a Lead Assessor I intend to:
 Meet the standards of regularity bodies (NMC, 2008)
 Demonstrate ongoing professional development/competence within critical care
 Promote a positive learning environment
 Support the learner to expand their knowledge and understanding
 Highlight learning opportunities
 Set realist and achievable action plans
 Complete assessments within the recommended timeframe
 Bring to the attention of the HEI, Education Lead and/or Manager concerns
  related to the individual nurses learning and development
 Plan a series of learning experiences that will meet the individuals defined learning needs
 Prioritise work to accommodate support of learners within their practice roles
 Provide feedback about the effectiveness of learning and assessment in practice


Signature ...............................................................   Date: ...................................



CRITICAL CARE LEAD NURSE/MANAGER
As a critical care service provider I intend to:
 Facilitate a minimum of 40% of learners' clinical practice hours with their mentor/assessor and/or
Practice Educator or delegated appropriate other
 Provide and/or support clinical placements to facilitate the learners development and achievement
of the core/essential competency requirements
 Regulate and quality assure systems for mentorship and standardisation of assessment to ensure
validity and transferability of the nurses' competence


Signature ...............................................................   Date: ...................................




                     National Competency Framework for Adult Critical Care Nurses
                           STEP THREE COMPETENCIES PAGE 4



Respiratory System
The following competency statements are about caring for the individual in the critical care environment who requires
advanced respiratory support, including monitoring, observation and respiratory care.



3.1 Advanced Anatomy & Physiology
You must be able to demonstrate through discussion
                                                                                     Achieved      Agreed Action Plan
application of your knowledge and current
                                                                                     Date/Sign         Date/Sign
evidence based practice in relation to:
 Pathophysiology, signs and symptoms and management of the following,
including how these conditions can effect choices of respiratory support:
  o COPD
  o Asthma
  o ARDs/ALI
  o Pneumonia and VAP
  o Pulmonary Embolism
 National & local policy & guidelines including:
  o ICS
  o BTS (2008)


3.2 Advanced Respiratory Assessment, Monitoring & Observation
You must be able to demonstrate through discussion
                                                                                     Achieved      Agreed Action Plan
application of your knowledge and current
                                                                                     Date/Sign         Date/Sign
evidence based practice in relation to:
 Supervision of junior staff to undertake a full respiratory assessment,
refer to competency Steps 1.2 & 2.2
 ABG analysis:
 o Importance of ABG analysis for:
 Respiratory management
 Renal management
 Acute surgical patients
 o Acidosis: causes and potential actions to rectify abnormality
 o Alkalosis: causes and potential actions to rectify abnormality
 o Offer advice to junior staff on treatment options following ABG analysis
 Rationale for Bronchoscopy
 Rationale for Proning/Kinetic therapy
 Rationale for appropriate care and management of chest drains
 Rationale for pharmacological therapies
You must be able to undertake the following in a safe and professional
manner underpinned by current evidenced based practice:
 Provide advice and support to junior staff in the assessment and
management of patients requiring respiratory care
 Correctly interpret and document ABG results
 Refer to appropriate team members for review as required
 Make recommendations on treatment changes based on findings
 Instigate appropriate care and management as required
 Re-evaluate progress and repeat ABG sample as required/appropriate
 Support junior staff during Bronchoscopy
 Instigate and support junior staff when caring for a patient undergoing
proning/kinetic therapy
 o Assemble a team and co-ordinates the proning of a patient,
ensuring airway is secure
 o Care for the patient in a manner that minimises potential complications
 Support junior staff in the safe management of patients with chest drains
 Support junior staff in the safe administration of pharmacological therapies




                      National Competency Framework for Adult Critical Care Nurses
                            STEP THREE COMPETENCIES PAGE 5


3.3 Advanced Non-Invasive and Invasive Ventilation
You must be able to demonstrate through discussion application of your           Achieved    Agreed Action Plan
knowledge and current evidence based practice in relation to:                    Date/Sign       Date/Sign

 Supervising the care of a patient requiring NIV or Invasive ventilation
 Modes of ventilation used in the clinical area, discussing the rationale
for use, potential advantages and disadvantages of each:
 o NIV
 o Pressure controlled ventilation
 o Volume or time cycled ventilation
 o High Frequency Oscillation
 o Inverse ratio ventilation
 o Extra Corporeal Membranous Oxygenation (ECMO)
 o Alveolar Recruitment techniques
 How ventilator settings can be manipulated to correct oxygen and/or
carbon dioxide imbalances as per ABG's, refer to competency Step 3.2
 Potential causes/consequences of abnormal ventilator parameters
 Methods to prevent/minimise potential physical and psychological
effects of positive pressure ventilation
 Rationale for End tidal CO2 monitoring:
 o Knows normal parameters, including trace/waveform
 o Can offer explanation for abnormal parameters
 o Misplaced tube
 o Suggest actions in the event of abnormal Et CO2 observations
 Likely causes for emergency re-intubation and discusses actions to
minimise risks
 The effectiveness of the Ventilator Care Bundle
 Lung Protective Ventilation and Predicted Body Weight parameters
 Weaning and extubation:
 o Effectiveness of weaning strategies
 o Provision of support & advice to other members of the MDT
You must be able to undertake the following in a safe and professional
manner underpinned by current evidenced based practice:
 Lead and supervise the care for a patient requiring NIV
 Lead and supervise the care of a patient requiring invasive ventilation
 Lead and supervise the care of a patient with a tracheostomy
 Escalate care appropriately when deterioration is noted
 Supervise junior staff when assisting with intubation
 Manually ventilate a patient in an emergency
 Establish patient on mechanical ventilation as directed
 Recommend and perform actions to improve gas exchange:
 o Auscultation
 o Suctioning
 o Patient positioning
 o Changes to ventilation parameters
 o Use of respiratory pharmacology
 Recommend further investigations including:
 o Chest imaging; CT; Bronchoscopy
 Assist physiotherapist to achieve treatment goals
 Continue physiotherapists plan in their absence
 Instigate and manage the weaning process support junior staff as appropriate
 Respond immediately to an:
 o Unplanned extubation
 o Unplanned decannulation
 Maintain airway and manually ventilate patient until more advance help
arrives, applying airway adjuncts as appropriate
 Apply effective interventions for patients experiencing airway problems:
 o Monitor the patient for potential complications associated with unplanned
extubation/decannulation, takes appropriate action & gives rationale
 o Communicates effectively with the patient
 o Oxygenation
 o Use tracheal dilators as required
 o Prepares for emergency intubation if required
 o Complete incident report according to trust policy
 o Support junior staff undertaking extubation


               National Competency Framework for Adult Critical Care Nurses
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