Palliative Care Nurse Practitioner Candidate

Clinical Competencies

Enhancing care through excellence in education and research

2

To download a copy of this booklet go to: www.centreforpallcare.org

To cite these competencies: Quinn, K., Glaetzer, K., Hudson, P., Boughey, M. Palliative Care Nurse Practitioner Candidate Clinical Competencies. Centre for Palliative Care, St Vincent’s Hospital Melbourne: Melbourne, Australia 2011.

Copyright 2011 Centre for Palliative Care, St Vincent’s Hospital Melbourne

Victorian Palliative Care Nurse Practitioner Collaborative c/- Centre for Palliative Care St Vincent’s Hospital Mailbox 65 PO Box 2900 Fitzroy, Victoria 3065 Australia Phone: +61 3 9854 1665

Authors:

• KarenQuinn,CoordinatorEducationandProjectOfficerforVictorianPalliative Care Nurse Practitioner Collaborative, Centre for Palliative Care, St Vincent’s Hospital & Collaborative Centre of The University of Melbourne

• KarenGlaetzer,NursePractitioner–PalliativeCare,SouthernAdelaidePalliative Services

• ProfessorPeterHudson,CentreforPalliativeCare,StVincent’sHospital& Collaborative Centre of The University of Melbourne and Queen’s University, Belfast, United Kingdom

• AssociateProfessorMarkBoughey,DirectorofPalliativeMedicine,StVincent’sHospitalandCo-DeputyDirector,CentreforPalliativeCare,St Vincent’s Hospital & Collaborative Centre of The University of Melbourne

Acknowledgments:

• IreneMurphy,NursePractitioner,MelbourneCitymissionPalliativeCareCommunity Service, Melbourne, Australia

• MembersoftheVictorianPalliativeCareNursePractitionerCollaborative,academics, clinicians and policy developers for generously giving of their time to review the document.

Funded by:DepartmentofHealthVictoria,Australia.

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Introduction ........................................................................................................ 4

Palliative Care Nurse Practitioner ........................................................................ 5

What is a Palliative Care Nurse Practitioner? .................................................. 5

What is a Palliative Care Nurse Practitioner Candidate? ................................. 6

Roleclarification ............................................................................................ 6

Policy context ..................................................................................................... 7

Key documents .................................................................................................. 8

Guiding principles ............................................................................................... 9

Generic NP guiding practice principles .......................................................... 9

SpecificPalliativeCareNPguidingpracticeprinciples ................................... 9

The Clinical Competencies ............................................................................... 11

Appendix 1: Bondy Scale ................................................................................. 20

Appendix 2: Australian Nursing and Midwifery Council Nurse Practitioner Competencies ..................................................................... 22

Contents

4

The purpose of this document is to provide Palliative Care Nurse Practitioner candidates in Victoria (and potentially candidates in other states of Australia), with a framework to ensure they meet core clinical competencies, to be achieved before they consider applying to the Nursing and Midwifery Board of Australia for EndorsementasaNursePractitioner.

The process for developing the clinical competencies was in six stages and included the following:

1. Establishmentofacorewritinggroupandundertakingaliteraturereview

2. DevelopingadraftofthecompetenciesinconsultationwithNursePractitioners

3. Review of the draft by members of the Victorian Palliative Care Nurse Practitioner Collaborative

4. Revisingandrefiningthedocumentbythewritinggroup

5. National and international expert opinion (including local and international nurse practitioners, members of the Victorian Palliative Care Nurse Practitioner Collaborative, palliative care physicians, policy developers, academics, a pharmacistandmembersofalliedhealth)tofurtherdevelopandrefinethecompetencies with the use of a purpose designed questionnaire

6. Final version of the Victorian Palliative Care Nurse Practitioner Candidate Clinical Competencies developed

These competencies aim to provide guidance to Palliative Care Nurse Practitioner Candidates and their services about how clinical competence in palliative care may beidentifiedandassessedintheworkplace.ItbuildsontheAustralianNursingandMidwifery Council’s document: Australian Nursing and Midwifery Council National Competency Standards for the Nurse Practitioner, 2004.

Nurse Practitioner Competencies provide a guide to a set of standards to demonstrate evidence of safe practice that align with the requirements, expectations and regulations of the role (Gardner, G. et al, 2006).

For further information on the Victorian Palliative Care Nurse Practitioner Collaborative visit: www.vpcnpc.centreforpallcare.org.

Introduction

5

Palliative Care Nurse Practitioner

What is a Palliative Care Nurse Practitioner?

A Nurse Practitioner (NP) is a registered nurse educated and endorsed to practice autonomously and collaboratively in an advanced and extended clinical role (Australian Nursing and Midwifery Council, 2009). The NP title is protected and only those nurses endorsed by the Nursing and Midwifery Board of Australia may call themselves a NP. From 1 July 2010, under national registration, Victorian palliative care (PC) NPs will be endorsed with a notation in the category of ‘acute and supportive care’. The notation is for the purpose of prescribing authority under Medicines, Poisons and Controlled Substances Act 1981.

The PC NP is able to demonstrate and deliver comprehensive assessment and management of palliative care patients (inclusive of client, consumers etc.) who have complex needs, using advanced nursing knowledge and skills informed by best practice principles. The practice of a PC NP may include, but is not limited to, the direct referral of patients to other health care professionals, prescribing medicines and ordering diagnostic investigations (Australian Nursing and Midwifery Council, 2004). The NP practises in a clinical leadership role, incorporating research, education and management into the role. “The scope of practice of the nurse practitioner is determined by the context in which the nurse practitioner is authorised to practice” (Australian Nursing and Midwifery Council, 2004).

APCNP’spracticeisdefinedbythenationallyagreedNPcompetencyframeworkthatidentifiesthreestandards:dynamicpractice,professionalefficacyand clinical leadership.

DynamicpracticeisdemonstratedbytheNP’shighlevelknowledgeandskillsinextended practice across stable, unpredictable and complex situations.

Professionalefficacydemonstratesthatpracticeisgroundedinanursingmodeland enhanced by autonomy and accountability.

Clinical leadership influences and progresses clinical care, policy and collaboration through all levels of health care (Australian Nursing and Midwifery Council, 2006).

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Underpinning the extended clinical practice of a NP are the key essential criteria of:

• Demonstratedwell-developedcommunicationskillstobuildtherapeuticrelationships with patients, families, colleagues and the community that recognise the patient’s needs, circumstances, preferences and geographical contexts

• Acommitmenttoongoingprofessionaldevelopmentofself,othernursesandother health professionals

• Demonstratedcapacitytoundertakeresearch/qualityimprovementactivitiesrelevant to enhancing the practice environment.

What is a Palliative Care Nurse Practitioner Candidate?

InVictoria,nurseswhohavebeenappointedbyanemployertobecomeaNParereferred to as NP Candidates (NPC). A PC NPC is a registered nurse employed by a service/organisation as they work toward meeting the academic (eg. approved NP Masters) and clinical requirements for endorsement as a Nurse Practitioner (NP).Duringtheperiodofcandidature,whichcanvaryinlength,thenurseconsolidates his/her competence at the level of a nurse practitioner, learning his/her new role while engaging with mentors and other learning opportunities both within and outside the candidate’s organisation.

Mentorship in terms of medical and senior nursing support, management skills and clinical teaching are essential components for effective skill development of the nurse practitioner candidate. A registered nurse engaged as a nurse practitioner candidateshallbeclassifiedandpaidtheirsubstantive(usual)salary(AustralianIndustrialRelationsCommission2006).

Role clarification

What are the differences between advanced practice nurses (including Clinical Nurse Specialists and Clinical Nurse Consultants) and Nurse Practitioners?

InAustralia,thetitleof‘NursePractitioner’isprotectedbylegislationandencompasses unique expanded practice privileges, which include authorisation to independently diagnose, prescribe medicines, order diagnostic tests and make referralstootherhealthcareprofessionals(Gardner,Chang&Duffield2007).

While advanced practice nurses are encouraged to complete postgraduate qualificationsspecifictothespecialtyareainwhichtheywork,theyarenotcurrently a requirement for the role. Advanced practice roles in Australia currently lack national consistency with regard to practice standards, unlike the NP role.

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Policy context

Victorian PC NPs have been appointed to better meet the Government’s palliative carepolicyobjectives,specificallytoensurethatallVictorianswithaprogressive,life-limiting illness and their families and carers have access to a high quality service system which fosters innovation (Strengthening Palliative Care: a policy for health andcommunitycareproviders,2004–2009).Buildingcapacitywithinthenursingworkforce with appropriately skilled and educated PC NP ensures the Government can meet its aims of:

• improvingtheequityofaccesstospecialistpalliativecareservicesforpeoplewith life-threatening illness

• buildingeffectiveandefficientlinksbetweenhospitalsandspecialistpalliativecare services

• buildingeffectiveandefficientlinksbetweenspecialistpalliativecareservicesand other relevant community, health and allied health providers, including disability services and residential aged care (Strengthening Palliative Care: apolicyforhealthandcommunitycareproviders,2004–2009).

PC NPs will be a pivotal link to realising priority three of the Victorian Cancer ActionPlan(2009–2011),whichistoincreasecapacityofpalliativecareservicesto provide care for patients in the place of their choice.

8

Key documents

Key documents underpinning the development of these competencies:

• AustralianNursingandMidwiferyCouncilNationalCompetencyStandardsfor the Nurse Practitioner, 2004.

• AustralianNursingandMidwiferyCouncilStandardsandcriteriafortheaccreditation of Nursing and Midwifery courses leading to registration, enrolment,endorsementandauthorisationinAustralia–withevidenceguide, 2009.

• QueenslandGovernmentQueenslandNursePractitioner:implementationguide, 2008.

• CanningD,YatesP,RosenbergJ.(2005)Competency standards for specialist palliative care nursing practice. Brisbane, Queensland University of Technology.

• GardnerG,CarryerJ,GardnerA,DunnS.(2006).NursePractitionercompetencystandards:findingsfromcollaborativeAustralianandNewZealandresearch. International Journal of Nursing Studies 43(5): pp601-610.

• CanadianNursesAssociationCanadianNursePractitionerCoreCompetencyFramework, 2005.

• GardnerG,ChangA,DuffieldC.(2007).Makingnursingwork:breakingthroughthe role confusion of advanced practice nursing. Journal of Advanced Nursing 57(4), 382-391.

• EagarK,SeniorK,FildesD,QuinseyK,OwenA,YeatmanH,GordonRandPosnerN,2003.ThePalliativeCareEvaluationToolKit:Acompendiumoftoolstoaidintheevaluationofpalliativecareprojects.CentreforHealthServiceDevelopment,UniversityofWollongong.

9

Guiding principles

The guiding principles underpinning the Palliative Care Nurse Practitioner Candidate Clinical Competencies are as follows.

Generic NP guiding practice principles:

1. PC NP candidates work within the agreed scope of practice for NPs within their employment context

2. The practice of a PC NP candidate is, wherever possible, based on best available evidence-based practice principles

3. Medical and nursing clinical supervision, management and education mentorship are all critical to the development of the PC NP candidate

4. The scope of an patient NP’s prescribing practice is supported by their employer’s clinical governance framework. As registered nurses, NP practice will also be guided by the Nursing and Midwifery Board of Australia’s professional practice framework that details how professional decision-making within a sound risk management, professional, regulatory and legislative framework is to be managed

Specific Palliative Care NP guiding practice principles:

5.ThepracticeofaPCNPcandidateisinformedbyclinicalexperiencespecificto the context of palliative care

6.Developingaplanofcareshouldinvolvethepatient,theirfamilyandotherrelevant health professionals

7. PC NP candidates have highly developed verbal and written communication skills essential to communicate assessment and management plan, including medicines, to the patient, carer/s, care team and other health professionals

8. PC NP candidates recognise the palliative care phase of illness of the patient and use this knowledge to inform their assessment and management. For example:

• Ifthepatienthasbeenstableandanacuteexacerbationofsymptomissuesoccurs, a full and thorough assessment should be undertaken to determine

10

anyreversiblecauses.Itwouldalsobeappropriatetoinitiateinvestigations(pathology and radiology) or referral to aid the diagnosis

• Ifthepatienthasbeenunstableandanacute,newproblemorunexpecteddeterioration occurs, a full and thorough assessment should be undertaken todetermineanyreversiblecauses.Itwouldalsobeappropriatetoinitiateinvestigations (pathology and radiology) or referral to aid the diagnosis. Candidates need to be able to recognise whether the new problem is related to the underlying disease process or a new, unrelated problem requiring referral

• Ifthepatienthasbeendeterioratinginapredictableandexpectedway,theassessmentmaybemodifiedandinvestigationslimited

• Ifthepatientisintheterminalphasewithevidenceofwelladvanceddiseaseand little possibility or expectation of recovery, it would be inappropriate to initiate a full assessment or investigations and the focus should be on the comfort of the patient

• Aplannedbereavementsupportprogramisavailableincludingcounsellingasnecessary(EagarK,SeniorK,FildesD,QuinseyK,OwenA,YeatmanH,Gordon R and Posner N, 2003)

11

The ClinicalCompetencies

12

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13

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14

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cess

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re p

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as

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onom

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s co

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ehen

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ptom

as

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ts.

Art

icul

ates

kno

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and

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ing

inte

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f sc

reen

ing

tool

s to

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ist

with

ass

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ent.

Per

form

s fu

ll sy

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s-ba

sed

appr

oach

to

phys

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ass

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ent.

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rpre

tsa

nda

rtic

ulat

es

colle

ctiv

efin

ding

sfro

m

phys

ical

exa

min

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n,

hist

ory,

inve

stig

atio

ns.

Find

ings

are

co

mpr

ehen

sive

ly

docu

men

ted,

co

mm

unic

ated

and

in

corp

orat

ed in

a

com

preh

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ve c

are

man

agem

ent p

lan.

Diff

eren

tiald

iagn

osis

is

iden

tified

.

Med

ical

men

tors

hip

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ntia

l to

achi

eve

com

pete

nce.

Med

ical

men

tor

requ

ired

toc

onfir

mc

ompe

tenc

e(D

epar

tmen

tofH

ealth

lo

gboo

k m

anda

tory

re

quire

men

t).

Ass

esse

d by

med

ical

and

pr

ofes

sion

al s

uper

viso

rs.

Sug

gest

usi

ng M

ini-

Clin

ical

Eva

luat

ion

Exe

rcis

e(m

ini-C

EX)

(Roy

al

Aus

tral

ian

Col

lege

of

Phy

sici

ans)

, whi

ch w

ould

al

low

for

full

obse

rvat

ion

of c

ases

incl

udin

g hi

stor

y ta

king

, exa

min

atio

n,

form

ulat

ion

of a

pla

n an

d,

impo

rtan

tly, o

ppor

tuni

ty

for

debr

ief/

disc

ussi

on.

Evi

denc

eof

com

pete

nce

to b

e lo

gged

in lo

gboo

k an

d si

gned

by

med

ical

su

perv

isor

.

Con

tinue

d…

15

Com

pet

ency

and

AN

MC

C

omp

eten

cy R

efer

ence

Key

ele

men

tsP

roce

ssP

erfo

rman

ce in

dic

ator

sA

sses

smen

t p

rinci

ple

s re

qui

red

to

dem

onst

rate

co

mp

eten

ce

2. C

ontin

ued

Lead

s ca

se d

iscu

ssio

n in

con

text

of h

ealth

car

e te

am m

eetin

g.

Indi

vidu

alc

andi

date

’s

leve

l of e

xper

ienc

e w

ill in

fluen

ce a

ctua

l num

ber

of a

sses

smen

ts re

quire

d to

ach

ieve

com

pete

.

Con

side

r us

ing

a B

ondy

sc

ale

(App

endi

x 1)

to

asse

ss c

ompe

tenc

e.

16

Com

pet

ency

and

AN

MC

C

omp

eten

cy R

efer

ence

Key

ele

men

tsP

roce

ssP

erfo

rman

ce in

dic

ator

sA

sses

smen

t p

rinci

ple

s re

qui

red

to

dem

onst

rate

co

mp

eten

ce

3. C

om

pre

hens

ive

psy

cho

log

ical

, so

cial

, sp

iritu

al a

nd c

ultu

ral a

sses

smen

t an

d im

ple

men

tatio

n o

f a

pat

ient

-fo

cuse

d c

are

pla

n

AN

MC

Com

pete

ncy

1.1

1.2

1.3

1.4

2.2

3.1

AN

MC

Nat

iona

l C

ompe

tenc

y S

tand

ards

fo

r th

e N

urse

Pra

ctiti

oner

(A

ppen

dix

2)

Det

erm

ine

the

patie

nt’s

ps

ycho

logi

cal,

soci

al,

spiri

tual

and

cul

tura

l co

ntex

t (in

clud

ing

the

fam

ily).

Con

duct

a

com

preh

ensi

ve

psyc

holo

gica

l, so

cial

, cu

ltura

l and

spi

ritua

l as

sess

men

t of c

urre

nt

stat

us a

nd r

isk

of p

oor

psyc

hoso

cial

wel

l-bei

ng

incl

udin

g:

•a

geno

gram

•fa

mily

his

tory

•so

cial

sup

port

and

ne

twor

ks

•ps

ycho

logi

calh

isto

ry

and

asse

ssm

ent

•id

entif

ying

mos

tsi

gnifi

cant

per

son

to

the

patie

nt

Use

of r

elev

ant v

alid

ated

to

ols.

Iden

tifica

tion

ofp

atie

nts

requ

iring

ong

oing

su

ppor

t.

Eva

luat

ese

ffica

cyo

ftr

eatm

ent p

lan

and

inte

rven

tion.

Art

icul

ates

kno

wle

dge

and

abilit

y, in

clud

ing

inte

rpre

tatio

n of

scr

eeni

ng

tool

s to

ass

ist w

ith

diag

nosi

s of

dis

orde

rs

incl

udin

g:

•de

pres

sion

•an

xiet

y

•di

stre

ss

•qu

ality

ofl

ife

•de

liriu

m

Art

icul

ates

pro

cess

an

d in

itiat

es re

ferr

al

to a

ddre

ss/m

anag

e ps

ycho

logi

cal,

soci

al,

spiri

tual

and

cul

tura

l is

sues

.

Med

ical

men

tors

hip

esse

ntia

l to

achi

eve

com

pete

nce.

Med

ical

men

tor

requ

ired

toc

onfir

mc

ompe

tenc

e(D

epar

tmen

tofH

ealth

lo

gboo

k m

anda

tory

re

quire

men

t).

Ass

esse

d by

med

ical

and

pr

ofes

sion

al s

uper

viso

rs.

Sug

gest

usi

ng M

ini-

Clin

ical

Eva

luat

ion

Exe

rcis

e(m

ini-C

EX)

(Roy

al

Aus

tral

ian

Col

lege

of

Phy

sici

ans)

, whi

ch w

ould

al

low

for

full

obse

rvat

ion

of c

ases

incl

udin

g hi

stor

y ta

king

, exa

min

atio

n,

form

ulat

ion

of a

pla

n an

d im

port

antly

, opp

ortu

nity

fo

r de

brie

f/di

scus

sion

.

Con

tinue

d…

17

3. C

ontin

ued

Mak

e re

ferr

al to

sp

ecia

list s

ervi

ce, w

here

ap

prop

riate

.

Pro

vide

s re

leva

nt a

nd

appr

opria

te in

form

atio

n an

d ed

ucat

ion

to th

e pa

tient

and

prim

ary

fam

ily

care

r/s.

Lead

s ca

se d

iscu

ssio

n in

con

text

of h

ealth

car

e te

am m

eetin

g.

Initi

ate

trea

tmen

t.

Evi

denc

eof

com

pete

nce

to b

e lo

gged

in lo

gboo

k an

d si

gned

by

med

ical

su

perv

isor

.

Indi

vidu

alc

andi

date

’s

leve

l of e

xper

ienc

e w

ill in

fluen

ce a

ctua

l num

ber

of a

sses

smen

ts re

quire

d to

ach

ieve

com

pete

nce.

Con

side

r us

ing

a B

ondy

sc

ale

(App

endi

x 1)

to

asse

ss c

ompe

tenc

e.

Com

pet

ency

and

AN

MC

C

omp

eten

cy R

efer

ence

Key

ele

men

tsP

roce

ssP

erfo

rman

ce in

dic

ator

sA

sses

smen

t p

rinci

ple

s re

qui

red

to

dem

onst

rate

co

mp

eten

ce

18

Com

pet

ency

and

AN

MC

C

omp

eten

cy R

efer

ence

Key

ele

men

tsP

roce

ssP

erfo

rman

ce in

dic

ator

sA

sses

smen

t p

rinci

ple

s re

qui

red

to

dem

onst

rate

co

mp

eten

ce

4. P

rep

arat

ion

for

safe

and

ap

pro

pri

ate

pre

scri

bin

g o

f m

edic

ines

AN

MC

Com

pet

ency

1.4

2.2

2.3

3.1

3.2

AN

MC

Nat

iona

l co

mp

eten

cy s

tand

ard

s fo

r th

e N

urse

Pra

ctiti

oner

(A

pp

end

ix 2

)

Ob

serv

e p

ract

ice

of

med

ical

col

leag

ues

in

rela

tion

to d

ecis

ion-

mak

ing

pro

cess

re

gard

ing

pre

scrib

ing

of

med

icin

es.

Bec

ome

fam

iliar

with

m

edic

ines

tha

t ca

n b

e p

resc

ribed

.

Eac

h nu

rse

pra

ctiti

oner

w

ill o

nly

pre

scrib

e fr

om

the

med

icin

e fo

rmul

ary

as d

eter

min

ed b

y th

e N

MB

A a

nd c

onsi

sten

t w

ith t

heir

scop

e of

pra

ctic

e. T

his

is

sup

por

ted

by

clin

ical

go

vern

ance

str

uctu

res

such

as

clin

ical

pra

ctic

e gu

idel

ines

at

thei

r w

orkp

lace

.

Und

er s

uper

visi

on

(dis

cuss

ion

and

m

ento

rshi

p):

Sel

ect

med

icin

e ap

pro

pria

te t

o p

atie

nt

and

sym

pto

m b

eing

tr

eate

d, p

atie

nt

pre

fere

nce

and

sta

ge o

f d

isea

se.

Con

sid

er a

cces

s to

m

edic

ine,

car

e se

ttin

g of

pat

ient

and

fina

ncia

l im

pac

t w

hen

pre

scrib

ing

med

icin

es.

Con

sid

er t

he Q

ualit

y U

se o

f Med

icin

es a

s p

art

of t

he d

ecis

ion-

mak

ing

fram

ewor

k.

Iden

tify

app

rop

riate

d

ose,

rou

te, f

req

uenc

y an

d t

itrat

ion

pla

n fo

r ea

ch m

edic

ine.

Pre

scrib

e ac

cord

ing

to

legi

slat

ion

guid

elin

es.

Art

icul

ates

clin

ical

in

dic

atio

ns o

f med

icin

es

that

can

be

pre

scrib

ed

and

are

con

sist

ent

with

th

e sc

ope

of p

ract

ice.

Dem

onst

rate

s co

mp

rehe

nsiv

e kn

owle

dge

of

pha

rmac

olog

y,

pha

rmac

okin

etic

s an

d

sid

e-ef

fect

s of

cla

sses

of

med

icin

es fr

om P

C N

P

pre

scrib

ing

list.

Dem

onst

rate

s ab

ility

to

sel

ect

med

icin

es

app

rop

riate

to

trea

t a

rang

e of

sym

pto

ms

com

mon

ly s

een

in

pal

liativ

e ca

re.

Dem

onst

rate

s ab

ility

to

ass

ess

effic

acy

of

med

icat

ion.

Ind

ivid

ual c

and

idat

e’s

leve

l of e

xper

ienc

e w

ill

influ

ence

act

ual n

umb

er

of a

sses

smen

ts r

equi

red

to

ach

ieve

com

pet

ency

re

qui

red

.

Med

ical

and

pha

rmac

y m

ento

rshi

p e

ssen

tial t

o ac

hiev

e co

mp

eten

ce.

Sug

gest

usi

ng M

ini-

Clin

ical

Eva

luat

ion

Exe

rcis

e (m

ini-

CE

X)

(Roy

al A

ustr

alia

n C

olle

ge

of P

hysi

cian

s), w

hich

w

ould

allo

w fo

r fu

ll ob

serv

atio

n of

cas

es

incl

udin

g hi

stor

y ta

king

, ex

amin

atio

n, fo

rmul

atio

n of

a p

lan

and

, im

por

tant

ly, o

pp

ortu

nity

fo

r d

ebrie

f/d

iscu

ssio

n in

clud

ing

dis

cuss

ion

of

med

icin

es a

pp

rop

riate

to

cas

e.

Con

tinue

d…

19

Com

pet

ency

and

AN

MC

C

omp

eten

cy R

efer

ence

Key

ele

men

tsP

roce

ssP

erfo

rman

ce in

dic

ator

sA

sses

smen

t p

rinci

ple

s re

qui

red

to

dem

onst

rate

co

mp

eten

ce

4. C

ontin

ued

Dem

onst

rate

d

awar

enes

s of

prin

cip

les

of d

ose

adju

stm

ent

with

reg

ard

to:

frai

l, el

der

ly, c

hild

ren,

alte

red

m

etab

olis

m, o

rgan

failu

re

and

imm

inen

t d

eath

Con

sid

er u

sing

a B

ond

y sc

ale

(Ap

pen

dix

1) t

o as

sess

com

pet

ence

(s

elf-

asse

ssed

by

cand

idat

e an

d t

hen

by

men

tor)

.

20

Appendix 1: Bondy Scale

Grade Performance criteria Quality of performance Assistance required

Independent(I) Level of clinical practice is of a high and safe standard

• soundleveloftheoretical knowledge applied effectively in clinical practice

• coordinatedandadaptable when performing skills

• achievesintendedpurpose

• proficientandperforms within expected time frame

• initiatesactionsindependently and in cooperation with others to ensure safe delivery of patient care

Without supporting cues

Supervised (S) Level of clinical practice is of a safe standard but with some areas of improvement required

• correlatestheoreticalknowledge to clinical practice most of the time

• coordinatedandadaptable when performing skills

• achievesintendedpurpose

• performswithinareasonable time frame

• initiatesactionsindependently most of the time and in cooperation with others to ensure a safe delivery of patient care

Requires occasional supportive cues

* (Bondy 1983)

21

Assisted (A) Level of clinical practice is of a safe standard but with many areas of improvement required

• demonstrateslimited correlation of theoretical knowledge to clinical practice

• attimeslackscoordination when performing skills

• achievesintendedpurpose most times

• performswithinadelayed time period

• lacksinitiativeandforesight

Requires frequent supportive cues and direction

Dependent(D) Level of clinical practice is unsafe if left unsupervised

• unabletocorrelatetheoretical knowledge to clinical practice

• lackscoordinationwhen performing skills

• unabletoachieveintended purpose

• unabletoperformwithin a delayed time period

• noinitiativeorforesight

Requires continuous supervision and direction

Bondy,K.N.,(1983).Criterion-referenceddefinitionsforratingscalesinclinicalevaluation. Journal of Nursing Education, 22(9), 376-382.

Grade Performance criteria Quality of performance Assistance required

Appendix 1 (continued)

22

Appendix 2: Australian Nursing and Midwifery Council Nurse Practitioner Competencies

Competency Framework

Standard 1: Dynamic practice that incorporates application of high-level knowledge and skills in extended practice across stable, unpredictable and complex situations

Competency 1.1: Conducts advanced, comprehensive and holistic health assessmentrelevanttoaspecialistfieldofnursingpractice.

Competency1.2:Demonstratesahighlevelofconfidenceandclinicalproficiencyin carrying out a range of procedures, treatments and interventions that are evidenced-based and informed by specialist knowledge.

Competency 1.3: Has the capacity to use the knowledge and skills of extended practice competencies in complex and unfamiliar environments.

Competency1.4:Demonstratesskillsinaccessingestablishedandevolvingknowledge in clinical and social sciences, and the application of this knowledge to patient care and the education of others.

Standard 2: Professional efficacy whereby practice is structured in a nursing model and enhanced by autonomy and accountability

Competency 2.1: Applies extended practice competencies within a nursing model of practice.

Competency2.2:Establishestherapeuticlinkswiththepatient/client/communitythat recognise and respect cultural identity and lifestyle choices.

Competency2.3:Isproactiveinconductingclinicalservicethatisenhancedandextended by autonomous and accountable practice

23

Standard 3: Clinical leadership that influences and progresses clinical care, policy and collaboration through all levels of health service

Competency3.1:Engagesinandleadsclinicalcollaborationthatoptimiseoutcomes for patients/clients/communities.

Competency3.2:Engagesinandleadsinformedcritiqueandinfluenceatthesystems level of health care.

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