Copyright © Renal Society of Australasia 2006. Reproduction without author permission prohibited.
The development of renal clinical
competencies across Europe.
Melissa Jane Chamney
Education Board EDTNA / ERCA.
Copyright © Renal Society of Australasia 2006. Reproduction without author permission prohibited.
The aim & why?
• Joint Collaboration Project
• Different skills / Different countries
• Produce a document that can be adapted to
specific country needs
• EU commitments
• Portability
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Competency
• Task Based
• Behavioural
• By developing a competency framework, it is
possible to identify all the "skills" required to
perform a job effectively (Whiddett &
Hollyforde 1999).
Copyright © Renal Society of Australasia 2006. Reproduction without author permission prohibited.
Nursing Framework
• Framework needed
• Benner (1984) “From Novice to Expert”.
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Benefits of developing and using a
competency framework
•
•
•
•
•
Training & development of staff
Recruitment & retention of staff
Performance review
Managing poor performance.
Ensure a quality service is provided to
patients
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Stage One
• Questionnaire completion by National
associations in conjunction with their renal
units.
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Vascular access care and management
Access and observe fistula site
Inject local anaesthetic subcutaneously
100
90
80
70
60
50
40
30
20
10
0
Greece
UK
Slovenia
Spain
Flanders
Israel
Portugal
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Haemodialysis care and management
Monitor blood flow rate
Administer nutritional supplement
Disconnect
Adequacy of dialysis
100
90
80
70
60
50
40
30
20
10
0
Greece
UK
Slovenia
Spain
Flanders
Israel
Portugal
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Fluid and electrolyte balance management
Set dry target weights
Interpret blood results
100
90
80
70
60
50
40
30
20
10
0
Greece
UK
Slovenia Spain
Flanders Israel
Portugal
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Peritoneal dialysis care and management
Educate patients on complications
Observe for complications
Collect adequacy tests
100
90
80
70
60
50
40
30
20
10
0
Greece
UK
Slovenia
Spain
Flanders
Israel
Portugal
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Stage Two
• Development of the competencies
• Skills for Health www.skillsforhealth.org.uk
• Piloting of the competencies across EU
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Stage Three
• Finalisation of the document
• CD Rom & paper back version.
• What it entails.
Copyright © Renal Society of Australasia 2006. Reproduction without author permission prohibited.
WORK WITH A PATIENT THROUGH A SESSION OF HAEMO DIALYSIS THERAPY.
This competence is about working with patients who are on a programme of haemodialysis therapy. It covers
a typical session of haemodialysis. The competence is divided into the phases of preparation, monitoring
during a session and conclusion of a session. The settings in which haemodialysis can be performed are in the
patient’s home, in hospital units or satellite units.
MANAGEMENT OF
CARE
COMPETENCIES
1.1
Work with a patient
through a session of
haemodialysis therapy
1.2
Prepare for
haemodialysis
therapy.
1.3
Connect the patient to
haemodialysis.
1.4
Support the patient
during haemodialysis
SE
AE
Date
Self Evaluation
[N] [AB] [C] [P] [E]
SE
AE
Date
Assessor Evaluation
[N] [AB] [C] [P] [E]
SE
AE
Date
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CRITERIA FOR CONSIDERATION
1.1
1.2
1.3
1.4
Identification of functional parts of machines in the unit. Able to perform function check to ensure safety of machines.
Assemble and prepare materials needed. Line and prime all machines safely and independently in accordance with the
manufacturer’s guidelines and provide rationale for priming. Understand the treatment of water used for dialysis.
Understand the principles of haemodialysis; demonstrate understanding of the concept of dry weight and importance of
accurate fluid assessment. Ensure correct dialyser is used. Able to discuss and implement different profiling techniques
based on assessment of patient. Able to identify contra- indications for treatment and take action to resolve contraindications. Keep an accurate record of measurements, information and advice given and any action taken
Consult the patient’s records with respect to the procedure. Ensure the required materials and equipment (as recommended
by national and/or local policies) are ready and fit for use before preparation of the patient. Take baseline physiological
measurements before starting the procedure and refer to the appropriate member of the multi disciplinary team if the
measurements are abnormal. Communicate openly with the patient and listen to any concerns or preferences they may have
in respect of their haemodialysis. Cease preparation where there are contra-indications before starting and take action to
resolve contra-indications. Keep an accurate record of the measurements, information and advice given and action taken.
Act to maintain dignity of the patient throughout the procedure. Identify the vascular access points, assessing these against
best practice criteria. Select the most appropriate site and prepare the vascular access using aseptic technique as per unit
policy. Recognise signs and symptoms of sepsis and take appropriate action. Ensure that prescribed infection control
measures are taken at all times. Offer local anaesthetic according to the patient’s preference (local hospital policy). Insert
needles by the method that will gain good access, cause minimal discomfort and prolong the life of the fistula. Inform the
patient of the activities being undertaken during dialysis in a way that is sensitive to their needs and concerns. For central
venous lines confirm that blood flow conforms to unit guidelines before connecting the patient to the extra-corporeal circuit.
Recognise complications and respond appropriately (Hypotension, Cramps, Nausea & Vomiting, Blown needles, Clotted
circuit, Air embolism, Cardiac arrest, Dialyser reactions, Disequilibrium syndrome amongst others). Routinely monitor blood
flow and other physiological parameters and adjust to ensure prescribed rate is administered. Identify machine alarms and
take appropriate action. Take action if the blood flow is not within guideline limits and refer to appropriate members of the
multidisciplinary team.
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APRECIAÇÃO, PLANEAMENTO E REAVALIAÇÃO DA TERAPÊUTICA DIALÍTICA
Esta competência está relacionada com as prescrições médicas, informações sobre as condições físicas
dos doentes e a sua adequação de modo a avaliar se a terapêutica dialítica a que o doente é sujeito
necessita de algumas alterações. Alguns ajustamentos devem-se às necessidades de novas prescrições
médicas e a alguns aspectos relacionados com a vida social, laboral e particular do doente.
GESTÃO DOS CUIDADOS
COMPETENCIAS
2.2
Apreciação sobre a eficácia
da diálise
2.3
Implementação das
mudanças propostas
CR
AR
Auto avaliação
[N] [AB] [C] [P] [E]
Date
CR
AR
Avaliação do responsável
[[N] [AB] [C] [P] [E]
Date
CR
AR
Date
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CRITÉRIOS A CONSIDERAR
2.2
Desenvolver, com o doente, os aspectos relacionados com os seus sentimentos acerca da diálise identificando os seus objectivos e aspirações
de forma a encontrar a melhor forma para que viva uma vida de bem-estar. Identificar o impacto que, o actual plano dialítico tem na sua vida
particular, laboral e social. Fazer uma avaliação sobre a aderência do doente à diálise bem como sobre o comportamento relativamente a
aumentos ponderais entre diálises, toma da medicação, acesso vascular ou outro. Estabelecer com o doente o seu estado nutricional, dando-lhe
indicações precisas sobre o que é mais adequado e esclarecendo todas as dúvidas que o doente possa ter a este respeito. Discutir com a
equipa multidisciplinar os aspectos que podem ser modificados e definir um plano de acção a curto e médio prazo por forma a implementar as
alterações propostas.
2.3
Discutir com o doente e a equipa multidiscilplinar, alterações possíveis ao plano de cuidados previamente instituído. Consciencializar o doente
para os riscos e benefícios que essas mesmas alterações podem acarretar e procurar a adesão do doente para este novo planeamento.
Negociar com o doente e pessoas significativas a melhor forma de implementação das alterações propostas e respeitar a confidencialidade.
Comunicar com o doente de maneira a que ele compreenda e aceite todos os novos ajustes de forma a que possa cumprir o que ficar
estipulado. Enfatizar o seu papel e o do doente nesta forma de negociação e compromisso, fazendo-lhe ver a importância de participar em
todas as decisões. Registar pormenorizadamente todas as alterações decididas e comunicá-las a todos os elementos da equipa multidisciplinar.
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Sponsorship thanks to:
Copyright © Renal Society of Australasia 2006. Reproduction without author permission prohibited.
References
•
Benner, P. (1984) From Novice to Expert, California, Addison
Wesley.
•
Eaton, A. (2006) Renal Competencies (Ed).
www.skillsforhealth.org.uk
•
Whiddett, S. & Holyforde, S. (1999) The Competencies
Handbook, Journal of European Industrial Training 23: 9.