the myeloma nursing competency framework · management and care of myeloma patients. 2. improve the...

The Myeloma Nursing Competency Framework

Contents

Using the Framework 4

Section one: KSF dimensions and myeloma-specific skills and knowledge 8

Competency Assessment Form 12

Section two: Core nursing competencies and myeloma-specific competencies 14

Core nursing competency 1: Collaborative working 14

Core nursing competency 2: Patient assessment 17

Core nursing competency 3: Patient safety 19

Core nursing competency 4: Pain management 22

Core nursing competency 5: Responding to changes in condition 25

Core nursing competency 6: Self-management 28

Core nursing competency 7: Meeting holistic needs of patients 30

Core nursing competency 8: Continuity of care 31

Core nursing competency 9: Transplant management 33

Core nursing competency 10: Accountability for practice 34

Appendix I: Background to the Framework 35

Appendix II: Monitoring and evaluation 37

References 38

About Myeloma UKMyeloma UK is the only organisation in the UK dealing exclusively with myeloma, a bone marrowcancer for which there is no cure, but many very effective treatments.

Our broad and innovative range of services cover every aspect of myeloma from providinginformation and support, to improving standards of treatment, management and care throughresearch and campaigning.

For more information about Myeloma UK and what we do, please visit www.myeloma.org.uk orcontact us at [email protected] or +44 (0)131 557 3332.

Date published: July 2012 Updated: November 2014 Date of review: November 2015

3

The Myeloma NursingCompetency Frameworkaims to:1. Provide UK standards which

outline the knowledge, skills and behaviours required by nurses involved in the treatment,management and care ofmyeloma patients.

2. Improve the patient experience by maximising the therapeuticalliance between the patient,doctor and nurse.

3. Reflect the increasing shift oftreatment, management and careto community settings.

The aims of the Framework The Myeloma Nursing Competency has been developedto enable nurses at all levels to demonstrate that they areequipped with the knowledge, skills, behaviours andcompetencies required to deliver the highest quality oftreatment, management and care to all myeloma patientsand their families in the UK.

Nursing competency -novice to expertThe Framework outlines theknowledge, skills and behavioursrequired by nurses of all Bands whoare involved in the treatment,management and care of myelomapatients and enables nurses toidentify, describe and demonstratetheir competence.

How to use the Framework The Framework has been developed in line with the NHSKnowledge and Skills Framework and current UK nursingpractice and is appropriate for use in all four UK homenations.

The Framework can be used by nurses at any levelinvolved in the treatment, management and care ofmyeloma patients. The Framework is relevant for allstages of myeloma in both acute and community caresettings including:

Diagnosis

Hospital care

Primary care

Treatment

Decisions about clinical trial participation

Management of symptoms and complications

Rehabilitation

Pre and post transplant care

Palliative and end of life care

Using the Framework

4

The role of the nurse in myelomatreatment Nurses have the following important roles to playin myeloma treatment, management and care :

A key member of the multidisciplinary team(MDT)

Ensuring that nursing goals reflect thechanging nature of myeloma as it progressesand as treatment, management and care areadapted to account for individual patientcircumstances and characteristics

Providing targeted information in the rightformat, at the right time to:

enable patients and their families to make informed decisions about their treatment, management and care

ensure patients are more in control of their cancer

support patients to recognise the importance of treatment compliance and reporting of side-effects, ensuring prompt resolution of any issues

The role of the nurse specialist inmyeloma treatmentAs well as those roles outlined previously, themyeloma nurse specialist will have additionalresponsibilities to:

Be the patient’s main point of contact,coordinating treatment, management and care

Ensure continuity of treatment, managementand care throughout all care settings

Use advanced skills in communication andeducation to support patients, their carers andfamilies at all stages of myeloma

Have the experience and judgement to assesspatients’ physical and psychological responsesto treatment and be able to take appropriateaction in a timely way

Contribute to achieving the best outcomes forthe patient

Act as a source of expertise for a wide range ofclinical staff involved in the treatment,management and care of myeloma patients butnot necessarily myeloma specialists or routinelyencountering myeloma patients

Myeloma is a rare, complex and heterogeneouscancer of the bone marrow. It is characterised bya wide range of comorbidities and serious clinicalcomplications including bone fractures, anaemiaand kidney damage.

Myeloma comprises 1.5% of overall cases ofcancer in the UK and is the second mostcommon blood cancer with 4,800 peoplediagnosed per year 1, and is about 1½ timesmore common in men than women and twice ascommon in Afro-Caribbean groups compared tothe Caucasian population.

There are approximately 12,500 people in the UK with myeloma at any one time 2. Myelomatypically occurs in older people, with a medianage at diagnosis of 70, meaning that manypatients have comorbidities which may impacton their treatment, management and careplans 3. There is no clear geographic distribution

of myeloma but there are marked variations inincidence between ethnic populations rangingfrom 3.9/100,000 in Chinese to 12.7/100,000 in African individuals 4.

Recent advances in myeloma treatment meanthat myeloma patients are living longer and canhave a greater proportion of treatment deliveredin an outpatient or community setting 5.However, whilst treatment options and overallsurvival figures have improved considerably inthe last decade, myeloma typically runs a courseof multiple remissions and relapses and still hasan ultimately fatal outcome for patients.

The complex clinical features of myeloma andthe range of complications associated with itmeans that the treatment, management andcare of myeloma patients is challenging,requiring input from a broad range of healthcareprofessionals in which nurses play a vital role.

Myeloma: an introduction

5

Section one – application ofKnowledge and Skills Frameworkdimensions to myelomaSection one sets out how the NHS Knowledgeand Skills Framework (KSF) can be applied tomyeloma. Nurses encountering myelomapatients for the first time may be competent inmany of the KSF dimensions appropriate fortheir Band, but will benefit from understandinghow the KSF dimensions translate to myelomaspecifically.

Competency assessment process

Nurses should examine the competencystatements in both sections, working with theirclinical supervisor or medical mentor asappropriate, to judge where they fit within theFramework and to identify what individual trainingor development they require. It is expected thatBand 5 – 6 nurses will be appraised by the clinicalnurse specialist and Band 7 and 8 nurses will beappraised by a consultant or a medical mentor. Itis suggested that steps 1 – 4 outlined belowshould be followed when using the Framework.

Step one:Nurses and their clinical nurse specialist/medicalmentor identify a competency or standard ofpractice that needs to be achieved.

Step two:Nurses and their clinical nurse specialist/medicalmentor identify how and by when the identifiedcompetencies are to be assessed and achieved.

Step three: Nurses collect evidence to demonstrate howrelevant competencies have been met.

Step four:Nurses and their clinical nurse specialist/medicalmentor evaluate whether the competency hasbeen achieved, and reflect on any furtherdevelopment, necessary actions and ongoingassessment.

Using the Framework

Section two – application of core nursing competencies tomyeloma-specific competenciesSection two of the Competency Frameworkdemonstrates how core nursing competenciestranslate to the competencies for thetreatment, management and care of myelomapatients. This section acknowledges that,irrespective of Agenda for Change Band, anynurse new to the field of myeloma will need toidentify and assess areas for development.

Collecting evidence to demonstratecompetence6

Nurses are responsible for developing their ownportfolio of evidence for each competency inorder to demonstrate that they have achievedthe identified/desired level. Forms of evidencethat can be used include case histories, self-appraisal via a reflective diary, 360-degreefeedback, verification of practice and structuredobservation of practice.

When gathering evidence it is important fornurses to:

Ensure they understand what thecompetency statement is asking of them

Review any existing work that could be used

Identify whether the existing evidence isappropriate

Consider what else they may need to do tocollect evidence

Think about using evidence that coversseveral competencies

6

There is a variety of material that can becollected to capture evidence of competenceand different approaches should be combined.Examples include:

Observation and critical analysis of everydaypractice

Audit and notes review

Case presentations

Excerpts from a reflective diary, with self-assessment of competence, identifieddevelopment needs and an action plan

Active contribution to policy groups,developing or revising guidelines, standardsor audits

Evidence of change or project management

Certificate of attendance and an evaluation ofthe outcomes of study days or courses

Demonstration of evidence-based practice,with supportive literature, protocols etc

Planning, delivering and evaluating teachingsessions

Individual performance review

360-degree feedback process

Personal and professional development portfolio

Active involvement in clinical supervision,mentorship and multidisciplinary meetings

Demonstrable ability to liaise with themultidisciplinary team and external agencies

A relevant contribution to a verbal discussionabout patient treatment, management and carethat is appropriate for the individual's level

Contribution to local or national documents, orjournals about service delivery, education etc

Leading or contributing to a journal club or other in-house teaching and learning sessions

Written documentation about patient treatment,management and care that is appropriate for the individual’s level

Examples of evidence

7

Sec

tion

one

: KS

F d

imen

sio

ns a

nd m

yelo

ma-

spec

ific

skill

s an

d k

now

led

ge

Leve

lS

kills

and

kno

wle

dg

e7N

HS

KS

F d

imen

sio

ns8

Leve

lM

yelo

ma-

spec

ific

Co

mp

eten

tnu

rse

(Ban

d 5

)

1.

Com

mun

icat

es s

ensi

tive

info

rmat

ion

conc

erni

ng p

atie

nt’s

med

ical

con

diti

on

2.

Has

pro

fess

iona

l/clin

ical

kno

wle

dge

acq

uire

d t

hrou

gh t

rain

ing

tod

egre

e/d

iplo

ma

leve

l

3.

Exe

rcis

es ju

dge

men

t in

ass

essi

ngp

rob

lem

s re

qui

ring

inve

stig

atio

n,an

alys

is

e.g.

ass

essm

ent

of p

atie

nt’s

cond

ition

, sui

tab

ility

for

dis

char

ge

4.

Ass

esse

s, p

lans

, im

ple

men

ts a

ndev

alua

tes

clin

ical

car

e of

pat

ient

s

5.

Org

anis

es t

heir

own

time

and

tha

tof

juni

or s

taff

and

lear

ners

Co

re d

imen

sio

ns

1.C

omm

unic

atio

n

2.P

erso

nal a

nd p

eop

le d

evel

opm

ent

3.H

ealth

, saf

ety

and

sec

urity

4.S

ervi

ce d

evel

opm

ent

5.Q

ualit

y

6.E

qua

lity

and

div

ersi

ty

Sp

ecifi

c d

imen

sio

ns

1.H

WB

1

2.H

WB

2

3.H

WB

3

4.H

WB

4

5.H

WB

5

6.H

WB

6

7.H

WB

7

Info

rmat

ion

and

kno

wle

dg

e

1.IK

2

2.IK

3

Gen

eral

1.G

1

3 3 2 2 2 2 1 3 1 2 3 3 3 2 2 1

1.

Effe

ctiv

ely

com

mun

icat

es

accu

rate

and

tim

ely

info

rmat

ion

to m

yelo

ma

pat

ient

s

2.

Has

a b

road

clin

ical

kno

wle

dge

of

mye

lom

a, p

rovi

des

ad

vice

for

pat

ient

s, t

heir

fam

ilies

and

oth

ercl

inic

al s

taff

3.

Ad

apts

nur

sing

mea

sure

s to

the

pat

ient

’s p

hase

of t

reat

men

t:

A

cute

pha

se

P

allia

tive

pha

se

R

ehab

ilita

tion

pha

se

P

re a

nd p

ost

tran

spla

nt

E

nd o

f life

car

e

4.

Und

erst

and

s m

yelo

ma

trea

tmen

td

ecis

ions

, ris

ks a

nd b

enef

its in

ord

er t

o ta

ke n

ursi

ng m

easu

res

top

reve

nt, t

reat

or

alle

viat

e m

yelo

ma

sym

pto

ms,

com

plic

atio

ns a

ndtr

eatm

ent

of s

ide-

effe

cts

5.

Rec

ogni

ses

thei

r ow

n lim

itatio

nsan

d a

re a

war

e of

the

con

trib

utio

nfr

om o

ther

col

leag

ues,

ask

ing

for

advi

ce a

nd s

upp

ort

as a

pp

rop

riate

Use

thes

e ta

bles

to u

nder

stan

d ho

w k

now

ledg

e an

d sk

ills o

utlin

ed in

the

NH

S K

SF

dim

ensi

ons

by n

ursi

ng B

ands

tran

slat

e to

spe

cific

ski

lls a

nd k

now

ledg

ene

eded

for

mye

lom

a tr

eatm

ent,

man

agem

ent a

nd c

are

. Doe

s yo

ur k

now

ledg

e of

mye

lom

a re

flect

the

skills

and

kno

wle

dge

for

your

Ban

d or

are

ther

ear

eas

of d

evel

opm

ent y

ou c

an id

entif

y?

8

Leve

lS

kills

and

kno

wle

dg

e7N

HS

KS

F d

imen

sio

ns8

Leve

lM

yelo

ma-

spec

ific

Exp

erie

nced

/p

rofic

ient

nur

se(B

and

6)

1.

Com

mun

icat

es s

ensi

tive/

high

lyse

nsiti

ve c

ond

ition

-rel

ated

info

rmat

ion

to p

atie

nts

and

rel

ativ

esw

ith e

mp

athy

and

rea

ssur

ance

2.

Has

pro

fess

iona

l kno

wle

dge

acq

uire

d t

hrou

gh d

egre

esu

pp

lem

ente

d b

y d

iplo

ma

leve

lsp

ecia

list

trai

ning

and

exp

erie

nce

3.

Has

ski

lls fo

r as

sess

ing

and

inte

rpre

ting

spec

ialis

t ac

ute

and

othe

r p

atie

nt c

ond

ition

s an

d t

akin

gap

pro

pria

te a

ctio

n

4.

Ass

esse

s, d

evel

ops

and

imp

lem

ents

sp

ecia

list

nurs

ing

care

pro

gram

mes

; ad

vise

s p

atie

nts

and

rel

ativ

es

5.

Con

trib

utes

to

dev

elop

men

t of

spec

ialis

t p

roto

cols

Co

re d

imen

sio

ns

1.C

omm

unic

atio

n

2.P

erso

nal a

nd p

eop

le d

evel

opm

ent

3.H

ealth

, saf

ety

and

sec

urity

4.S

ervi

ce d

evel

opm

ent

5.Q

ualit

y

6.E

qua

lity

and

div

ersi

ty

Sp

ecifi

c d

imen

sio

ns

1.H

WB

1

2.H

WB

2

3.H

WB

3

4.H

WB

4

5.H

WB

5

6.H

WB

6

7.H

WB

7

Info

rmat

ion

and

kno

wle

dg

e

1.IK

1

2.IK

2

3.IK

3

Gen

eral

1.G

1

2.G

2

3.G

4

4.G

5

5.G

6

6.G

7

3 3 3 2 3 3 3 3 2 3 3 3 3 2 2 3 2 1 1 3 1 1

As

Ban

d 5

plu

s:

1.

Com

mun

icat

es a

nd d

iscu

sses

w

ith p

atie

nts

that

mye

lom

a is

lif

e-lim

iting

and

exp

lain

s tr

eatm

ent

and

sid

e-ef

fect

s

2.

Rec

ogni

ses

opp

ortu

nitie

s to

enha

nce

trea

tmen

t, m

anag

emen

tan

d c

are

to t

he p

atie

nt

3.

Ob

serv

es a

nd a

sses

ses

a p

atie

nt’s

need

for

acut

e in

terv

entio

ns a

nd/o

rho

spita

l ad

mis

sion

for:

C

hem

othe

rap

y

S

epsi

s

B

leed

ing

G

VH

D

S

pin

al c

ord

com

pre

ssio

n

4.

Rec

ogni

ses

norm

al a

nd a

bno

rmal

par

amet

ers

of m

yelo

ma

and

com

mun

icat

es t

hese

to

pat

ient

san

d r

elat

ives

5.

Par

ticip

ates

in m

yelo

ma

pra

ctic

ed

evel

opm

ent

and

tra

inin

g in

itiat

ives

9

Leve

lS

kills

and

kno

wle

dg

e7N

HS

KS

F d

imen

sio

ns8

Leve

lM

yelo

ma-

spec

ific

Clin

ical

nur

sesp

ecia

list

(Ban

d 7

)1.

C

omm

unic

ates

sen

sitiv

e, c

omp

lex

cond

ition

-rel

ated

info

rmat

ion

top

atie

nts

and

rel

ativ

es w

ith e

mp

athy

and

rea

ssur

ance

2.

Has

pro

fess

iona

l kno

wle

dge

acq

uire

d t

hrou

gh d

egre

e/d

iplo

ma

sup

ple

men

ted

by

spec

ialis

t tr

aini

ng,

exp

erie

nce

and

/or

shor

t co

urse

s to

mas

ter’s

leve

l eq

uiva

lent

3.

Has

ski

lls n

eces

sary

to

asse

ss a

ndin

terp

ret

spec

ialis

t ac

ute

and

oth

erp

atie

nt c

ond

ition

s an

d t

akin

gap

pro

pria

te a

ctio

ns

4.

Pla

ns s

pec

ialis

t nu

rsin

g se

rvic

ep

rovi

sion

, inc

lud

ing

educ

atio

n an

d t

rain

ing

5.

Ass

esse

s, d

evel

ops

and

imp

lem

ents

sp

ecia

list

nurs

ing

care

pro

gram

mes

Co

re d

imen

sio

ns

1.C

omm

unic

atio

n

2.P

erso

nal a

nd p

eop

le d

evel

opm

ent

3.H

ealth

, saf

ety

and

sec

urity

4.S

ervi

ce d

evel

opm

ent

5.Q

ualit

y

6.E

qua

lity

and

div

ersi

ty

Sp

ecifi

c d

imen

sio

ns

1.H

WB

1

2.H

WB

2

3.H

WB

3

4.H

WB

4

5.H

WB

5

6.H

WB

6

7.H

WB

7

Info

rmat

ion

and

kno

wle

dg

e

1.IK

2

2.IK

2

3.IK

3

Gen

eral

1.G

1

2.G

2

3.G

3

4.G

4

5.G

5

6.G

6

7.G

7

4 4 4 3 3 4 3 4 3 4 4 4 4 3 3 4 3 3 2 2 3 4 2

As

Ban

d 5

and

6 p

lus:

1.

Sup

por

ts p

atie

nts

und

ergo

ing

dia

gnos

tic p

roce

sses

2.

Has

sp

ecifi

c cl

inic

al e

xper

tise

(in-d

epth

kno

wle

dge

and

und

erst

and

ing

of m

yelo

ma)

3.

Und

erta

kes

med

icin

esm

anag

emen

t fo

r m

yelo

ma

pat

ient

s.C

ritic

ally

ass

esse

s p

resc

riptio

ns t

om

axim

ise

pat

ient

man

agem

ent

and

reco

very

4.

Initi

ates

and

imp

lem

ents

sta

ndar

ds

of n

ursi

ng t

reat

men

t, m

anag

emen

tan

d c

are

for

mye

lom

a p

atie

nts:

D

evel

ops

new

ap

pro

ache

s to

ru

nnin

g se

rvic

es

U

nder

take

s st

rate

gic

pla

nnin

g to

inco

rpor

ate:

sp

ecifi

c sp

ecia

lity

need

s

ev

iden

ce-b

ased

pra

ctic

e

Ju

dge

s q

ualit

y an

d r

elev

ance

of

new

clin

ical

info

rmat

ion

5.

Pro

vid

es n

urse

-led

clin

ics

asap

pro

pria

te s

uch

as p

re a

nd p

ost

tran

spla

nt a

nd in

pat

ient

/out

pat

ient

clin

ics

10

Leve

lS

kills

and

kno

wle

dg

e7N

HS

KS

F d

imen

sio

ns8

Leve

lM

yelo

ma-

spec

ific

Nur

se c

ons

ulta

nt

(Ban

d 8

a, b

, c)

1.

Com

mun

icat

es v

ery

sens

itive

,co

mp

lex

cond

ition

-rel

ated

info

rmat

ion

to p

atie

nts

and

rela

tives

, with

req

uire

d e

mp

athy

and

rea

ssur

ance

, pre

sent

ssp

ecia

list

info

rmat

ion

to la

rge

grou

ps

of s

taff

2.

Has

pro

fess

iona

l kno

wle

dge

acq

uire

d t

hrou

gh d

egre

e/d

iplo

ma

sup

ple

men

ted

by

spec

ialis

t tr

aini

ng,

exp

erie

nce,

sho

rt c

ours

es t

om

aste

r’s le

vel e

qui

vale

nt

3.

Mak

es o

per

atio

nal j

udge

men

ts,

man

ages

con

flict

ing

view

s,re

conc

iles

inte

r an

d in

tra

pro

fess

iona

l diff

eren

ces

of o

pin

ion

4.

Pla

ns s

pec

ialis

t nu

rsin

g p

rovi

sion

incl

udin

g ed

ucat

ion

and

tra

inin

g

5.

Dev

elop

s an

d im

ple

men

ts s

pec

ialis

tca

re p

acka

ges,

pro

vid

es c

linic

alad

vice

in s

pec

ialis

t ar

ea

Co

re d

imen

sio

ns

1.C

omm

unic

atio

n

2.P

erso

nal a

nd p

eop

le d

evel

opm

ent

3.H

ealth

, saf

ety

and

sec

urity

4.S

ervi

ce d

evel

opm

ent

5.Q

ualit

y

6.E

qua

lity

and

div

ersi

ty

Sp

ecifi

c d

imen

sio

ns

1.H

WB

1

2.H

WB

2

3.H

WB

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13

This section translates core nursing competencies to myeloma-specific competencies, settingout the knowledge, skills and behaviours required for nurses treating myeloma patients.Remember that there may be specialist myeloma practice which you are not familiar with,whatever Band you are working at.

The Framework maps out myeloma-specific competencies against Benner 9 stages 3, 4 and 5– competent, proficient and expert nurses in the field.

Core nursing competency 1: Collaborative working

Section two: Core nursing competencies andmyeloma-specific competencies

Competent myeloma nurse Proficient myeloma nurse Expert myeloma nurse

Knowledge Knowledge Knowledge

1. Develops a knowledge andunderstanding of theaetiology and possiblecauses of myeloma

1. Acts on the pathology ofmyeloma to identify andimplement managementoptions

1. Specialist in-depth clinicalexpertise and understandingof myeloma and myelomatreatments, includingawareness of potential futuretreatments

2. Shows awareness of possiblepathways to diagnosis formyeloma patients

2. Understands the differencesin presentation, symptomsand management options for both symptomatic andnon-symptomatic myeloma

2. Designs, develops,implements and evaluatescare pathways for myelomamanagement which addressindividual patient and familycircumstances and socialdemographics

3. Demonstrates an awarenessof staging and prognosticfactors associated withmyeloma

3. Applies managementstrategies tailored to eachdistinct stage of myeloma

3. Develops, leads andmanages strategies tailoredto patients at different stagesin their myeloma trajectory

4. Is able to discuss thediagnosis with the patientand their family/carer

Provides appropriateinformation to patients aboutmyeloma which is accurateand up-to-date, usingexternal resources and theircontact details

Revisits this at different timepoints in the course of theillness

4. Recognises, states and putsinto practice the individual’srights to information, andwhat information is relevantand most useful duringdifferent phases of myelomatreatment

4. Has in-depth knowledge of the role and needs of the myeloma patient’sfamily/carer and providestailored information as part of a structured approach totreatment, management and care

5. Develops an understandingof the presentation,symptoms, managementoptions and adverse effectsof treatment

5. Ensures myeloma patientsare aware of the risks of theirmyeloma and treatment

5. Develops protocols/guidelines to ensure a safe approach to myelomatreatment, management and care

14



6. Shows awareness of theinvestigative procedures usedthroughout patients’myeloma pathways

6. Has a critical understandingof the investigativeprocedures used withinmyeloma and uses this toassist decision-making

6. Ensures patient feedback isincorporated into proceduresand standards wherepossible

7. Shows awareness andunderstanding of the testinginvolved in a ‘myelomascreen’

7. Can describe the testsinvolved in a ‘myelomascreen’ to patients,families and other staff

7. Has in-depth knowledge andunderstanding of thediagnostic tests used withinmyeloma and can interpretthe data for discussion withthe patient

8. Shows awareness of local and national procedures and guidelines affecting thetreatment, management andcare of myeloma patients

8. Is aware of, and implements,national, local andorganisational proceduresthat affect an individual withmyeloma

8a. Leads the implementationand monitoring of nationaland local procedure withinthe unit

8b. Evaluates existingprocedures and wherenecessary inputs into thedesign and development ofnew local and nationalprocedures

Skills Skills Skills

1. Can recognise the presentingfeatures of myeloma

1. Can recognise risk factorsassociated with a diagnosisof myeloma:

Anaemia

Thrombotic risks

Hypercalcaemia

Bone disease

Infection

Osteonecrosis of the jaw(ONJ)

1. Initiates interventionstrategies to manage riskfactors associated withmyeloma

2. Works as part of themultidisciplinary team toensure referral to othercolleagues if necessary, tosupport the information needsof patients and their carers

2. Represents the patient withinthe multidisciplinary teammeetings and understandsthe referral/support needs ofthe patient

2. Has expertise and is a keymember of the widermultidisciplinary teamincluding primary/community/secondary care and commissioners

3. Has awareness of the impacta diagnosis of myeloma hason the person with myeloma,their family and friends

3. Is able to identify the areas of support required by thepatient and their familyfollowing diagnosis and hasan understanding of servicesto meet those support needs

3. Coordinates, signposts andimplements appropriatesupport services andorganisations for a caseloadof myeloma patients

15


Behaviours Behaviours Behaviours

1. Exhibits empathy,compassion and respect forthe individual patient fromdiagnosis and throughouttreatment

1. Works collaboratively withpatients and their families to facilitate understanding of myeloma diagnosis,treatments and risk factors

1. Acts as an advocate for acaseload of myelomapatients to ensure healthneeds are met consistentwith patients’ wishes

2. Recognises the impact ofmyeloma on the patient andfamily

2. Supports patients in complextreatment decisions withappropriate information

2. Puts systems in place toensure clear and consistentinformation is available forpatients from the outset aspart of a structured approachto treatment, managementand care

3. Seeks input and advice frommore senior nurses, doctorsand allied healthcareprofessionals, whennecessary

3. Displays effective team workwith wider members of themultidisciplinary team

3. Collaborates acrossprofessions and voluntarysector to develop newpartnerships

16

Core nursing competency 2: Patient assessment



1. A working knowledge of theneeds of individuals withmyeloma and the resourcesand services available tosupport them

1. Assesses complex health andwellbeing needs as theychange across the case loadand myeloma trajectory

1. Identifies service needs anddeficits and developsstrategic plan for service

2. Aware of clinical rating toolsand their use

2a. Has a knowledge of clinicalrating tools to assess needs:

SPARC tool10

Distress Thermometer11

HAD12

2b. Understands the limitationsassociated with the clinicaluse of scales

2a. Identifies scales appropriatefor specific clinicalmeasurement, particularly inclinical studies for example:EORTC QOL C3013 plusmyeloma-specific QLQ14 15,MY20

2b. Understands the significanceof data related to outcomemeasures

3. Undertakes a holisticassessment to determineaccurately actual andpotential problems

3. Makes decisions incollaboration with patientsand other team membersabout prioritising treatmentmanagement and care forpatients with varying needs

3. Works with a range ofhealthcare professionals todesign and implement carepathways in anticipation ofpotential problems

4. Has knowledge of referralpathways for professionalpsychological support forpatients

4. Refers to other healthcareprofessionals such aspsychology services toprovide additional support

4. Collaborates with widerinterprofessional networks toensure that patients haveaccess to the professionalservices they require

5. Uses an evidence-based andperson-centred assessmentapproach to identify healthand education needs

5. Addresses patient andfamily/carer health andeducation needs as astructured approach totreatment, management and care

5. Evaluates the needs of acaseload of patients on aregular basis throughout their myeloma pathway, andassesses and develops oraccesses health educationresources to address theseneeds


1. Adapts nursing measures to the specific phase oftreatment to maximise apatient’s wellbeing

1. Selects clear decision-making processes to achievecare that is evidence-based

1. Has the ability to assesspsychological distress usingwell established tools

2. Documents clear andaccurate information aboutthe patient arising from theassessment

2. Monitors the assessment andcare planning of the team toensure a range of needs aremet with patients at differentstages of diagnosis withmyeloma

2. Able to outline the needs of a caseload of myelomapatients and use this tofacilitate service improvement

17



1. Listens to the impact thatmyeloma is having on thepatient and family

1. Acts on patient’s narrative todevelop a care plan

1. Coordinates with widerinterprofessional networksand developsrecommendations forchannels of communicationbetween specialist andgeneralist services,healthcare and social care

18

Core nursing competency 3: Patient safety



1. Aware of the anti-tumouragents used in the treatmentof myeloma

1. Has a wide knowledge andputs into practice differentanti-tumour agents used inthe treatment of myeloma

1a. Has expert knowledge andexperience of the use ofdifferent anti-tumour agentsused in the treatment ofmyeloma

1b. Involved in developmentresearch and contributes to innovations in myelomamanagement

2. Understands assessment andre-assessment of a myelomapatient receivingchemotherapy

2. Is capable of performingaccurate and comprehensiveclinical assessments andreassessments of a myelomapatient on chemotherapy.Selects or develops riskassessments which includevenous thromboembolicevents (VTE) and peripheralneuropathy (PN)

2. Performs assessment of both acute and long-termconsequences of myeloma,recognising the patient’sresponse to their illnessexperience

3a. Demonstratespharmacological knowledgeto ensure safe handling andadministration of drugs usedfor myeloma patients

3b. Shows awareness of novelagents used in the treatmentof myeloma

3c. Recognises drugs that maybe contraindicated in themanagement of myeloma

3a. Discusses and explains the drugs used in themanagement of myelomapatients, their carers, andother healthcareprofessionals

3b. Demonstrates anunderstanding of the use andmanagement of novel agents

3c. Administers and suppliespharmacological agents

3a. Leads on total interventionmanagement in line withnational and local protocols

3b. Monitors and evaluates theeffectiveness ofpharmacological agents

3c. Leads on the risk reporting ofadverse events for inclusionin audit and policy reviews

4. Develops understanding ofprotocols and their use ineffective drug management

4. Revises and updatesestablished protocols whichuse haemopoietic growthfactors and antifungal agents

4a. Oversees effectiveimplementation of protocolsand makes recommendations

4b. Uses in-depth clinical and research knowledge toempower patients to makewell informed decisionsabout participating inmyeloma research

5. Uses accurate and up-to-date information to makedecisions

5. Uses judgement anddecisions to improve practice

5. Works both independentlyand within themultidisciplinary team to make clinical judgements and decisions

19


6. Has an understanding ofbone marrow suppressionand haematological andbiochemistry values

6. Has an in-depth knowledgeof the effects of myeloma onthe bone marrowmicroenvironment andbiochemistry values

6. Has specialist expertise ineffects of myeloma on thebone marrowmicroenvironment andbiochemistry values, andprovides education andtraining about these to staff

7. Is aware of risks associatedwith central venous accessdevices (CVAD) andundertakes flushing/bleedingaccording to local protocol

7. Can identify and report therisks associated with CVADto patients and recommendpreventative measures toreduce risks

7. Implements, evaluates andupdates protocols for the use of CVAD for myelomapatients


1a. Acts proactively whenreceiving haematological andbiochemistry results andrecognises complex issuesbeyond personal scope

1b. Knows who to contact forfurther information, supportand advice

1. Acts on the results ofhaematological andbiochemistry results byadjusting the patient’smanagement plan

1. Has specialist expertise inhaematological andbiochemistry results andprovides training to widermembers of themultidisciplinary team

2. Works with and managescentral venous catheters andcentral lines to minimise riskof complications

2. Works with and managescentral venous catheters andcentral lines to minimise riskof complications

2. Performs assessment ofcomplications and influencesthe development andimprovement of localprotocols

3. Is able to recognise sepsis,bleeding, medullarycompression and coagulationdisorders

3. Takes responsibility foradmissions to ward area ofpatients suspected withneutropenic sepsis, bleedingand medullary compression,initiating emergencytreatment according toprotocols and monitoring thepatient

3. Uses clinical judgement totreat sepsis, bleeding andmedullary compression andrefers patients as anoncological emergency

4. Has completed the BETTER16

blood transfusion programme4. Supervises and supports

nurses undertaking theBETTER blood transfusioncontinuing educationprogramme

4. Reviews and evaluates theeducational needs of nursesundertaking the BETTER andblood transfusion educationprogrammes

5. Provides the patient with anemergency contact numberand explains its use to thepatient

5. Triages emergency contactsfrom patients

5. Monitors patient emergencycontacts and developsimprovements to emergencycare, co-ordinating with otheragencies, services ordepartments e.g. primarycare out of hours services

20



1. Communicates informationeffectively to the patientwhen undertaking proceduresrelating to chemotherapy,CVAD or administration ofblood products

1. Contributes to, and workseffectively with, the widermultidisciplinary team toensure procedures,treatments and care are safeand effective

1. Exhibits leadership in patientsafety matters

21

Core nursing competency 4: Pain management



1. Has an awareness of the highincidence of pain amongmyeloma patients and iscapable of diagnosing thecause

1. Has extensive knowledge ofthe various causes of pain inmyeloma

1. Obtains, analyses andinterprets history, presentingsymptoms, and diagnosticinformation to develop theappropriate differentialdiagnoses

2. Has a working knowledge ofpain assessment tools andpharmacological strategies tomanage pain

2. Has in-depth understandingof cancer pain assessmenttools and analgesic drugs

2. Monitors and evaluates pain assessment tools andmakes recommendations for modification andimprovement

3. Shows understanding of theconsiderations for painmanagement and appropriatemethods for pain relief

3. Can identify the regulatoryissues that impact on painmanagement and is capableof undertaking acomprehensive assessmentusing a standardised painassessment tool; recognisingthe impact of comorbiditiesamong older patients

3. Uses expertise to coordinate,and contribute towards themultidisciplinary managementof the patient’s pain

4. Is knowledgeable regardingdifferent categories of pain,acute, chronic andbreakthrough

4. Demonstrates and appliesnon-pharmacologicalinterventions in clinicalpractice includingpsychological support

4. Develops protocols andguidelines which minimisethe regulatory issues thatimpact on effective painmanagement

5. Demonstrates the ability torecognise physiological signsassociated with pain such astachycardia and hypertension

5. Has knowledge of thebenefits of NSAIDS in acute,short-term circumstances formyeloma patients

5. Works with specialist teamswho provide anaestheticprocedures such as nerveblocks and epidural cathetersto coordinate and supportpre and post procedure carefor the myeloma patient

6. Demonstrates andappropriately applies non-pharmacologicalinterventions in clinicalpractice such as positioning,distraction and relaxation

6. Has extensive knowledge of evidence-basedpharmacological therapiesused alongside radiotherapy

6. Administers, supplies andaudits pharmacologicalagents

7. Knows the major risks ofNSAIDS such as renal failureand diminished plateletfunction and the impact ofthis on myeloma patients

7. Recognises the commonside-effects of adjuvantanalgesics

7. Develops strategies foreducating patients on the importance of earlydetection of side-effects and recommends self-management tips for patients

22



8. Is able to describe thepotential side-effects of opioids

8. Makes recommendations for opioid use taking intoaccount potential side-effects

8. Writes protocols for use of opioids

9. Understands the rationale foruse of bisphosphonates inmanaging cancer pain

9. Has in-depth understandingof the different classes ofbisphosphonates and theirdifferent modes of action

9. Has expertise inbisphosphonates,recognising lifestyle factors affecting choice of bisphosphonates


1. Aware of the need to educatepatient, family and significantothers about painmanagement

1. Includes and provides thepatient, family and significantothers with information about all aspects of painmanagement throughongoing education and withreference to:

Their role in painmanagement

The impact of unrelieved painon the individual

Overcoming barriers toeffective pain management

The pain management planand expected outcomes ofthe plan

1. Analyses patient and familyfeedback to identify anyrequired strategic changes tothe use of pain managementtools and pain services

2a. Understands andcommunicates with thepatient about individualpatient factors that affecttheir pain threshold

2b. Discusses self-managementtips with patients to helpthem to manage their pain

2. Recognises how personalattitudes, beliefs, values,influences and culturalbackground can affect theirinterpretation of a patient’spain

2a. Competent in theassessment andmanagement of pain

2b. Selects appropriatediagnostic and therapeuticinterventions with respect to:

Safety

Cost

Effectiveness

Timing

Acceptability

23



1. Listens to the patient’s painpattern, pain experiences and pain management withempathy and respect

1. Exhibits advanced listeningskills when interacting with the patient about painexperiences and painmanagement

1. Evaluates the patient’s painpatterns and identifies areasfor prevention and effectivemanagement

2. Recognises the impact ofpain on the patient and theirfamily

2. Promotes the use of a varietyof pain managementstrategies to reduce patientdistress

2. Recognises the importanceof the patho-physiology ofmyeloma in the managementof the patient’s pain

24

Core nursing competency 5: Responding to changes in condition



1a. Acts on advice from seniornurses/doctors to initiatepreventative measures

1b. Is able to work within amultidisciplinary team andunderstand the role of eachperson, referring asappropriate

1a. Demonstrates anunderstanding of thephysiology of symptoms andside-effects which manifestamong myeloma patients

1b. Accurately assessessymptoms associated withmyeloma and its treatment,distinguishing the cause

1. Has extensive knowledge ofthe patho-physiologicalreasons for symptoms inmyeloma

2. Develops a knowledge ofsymptoms associated withmyeloma and the treatmentused to alleviate them

Peripheral neuropathy (PN)

Hypercalcaemia

Spinal cord compression

Infection

Bone disease

Thrombotic risks

2. Takes responsibility forleading the team in managingthe following:

Peripheral neuropathy (PN)

Has knowledge of:

Myeloma-related PNincluding spinal cordcompression

Chemotherapy induced PN

Assessment and investigationof PN using appropriate toolsespecially prior to each cycleof chemotherapy

Hypercalcaemia

Has knowledge of:

Symptoms of hypercalcaemia

Usual blood parameters

Bisphosphonate use inmyeloma treatment

Infection

Has knowledge of:

Infection risk associated withmyeloma

Infection risk associated withthe treatment

Steroid use and the link toincreased infection risk

Patient educationrequirements to minimiseacute episodes

Awareness of vaccinationrecommendations againstinfluenza within haematologypractice

2a. Leads as well as initiatesclinical practice developmentinitiatives in relation tosymptom management,protocol development andsafe practice

2b. Chooses interventions basedon a sound rationale andaccepted best practice

25



Bone disease

Has knowledge of:

Presenting patients extent of bone disease and carerequired to minimisediscomfort

Reasons for bone destruction

Thrombotic episodes

Has knowledge of:

Risk to a myeloma patient ofthe development of a VenousThromboembolic Event (VTE)

Methods which include riskassessment for all patientsreceiving thalidomide andlenalidomide

Patient related (comorbidities) risks

3. Demonstrates understandingof the blood test panels andthe implications of theirresults

3. Has in-depth knowledge ofthe reference values for bloodtest panels and the cause ofabnormal values

3. Can critically evaluate andinterpret blood values as asign of myeloma progression

4. Provides immediate care andcompetence when dealingwith an acute situation: usinga range of technical skills,venepuncture, cannulation,central venous access devicemanagement, a systematicassessment approach andgood interpersonal andcommunication skills

4. Takes responsibility forpatient management in acutesituations

4. Leads the development ofprotocols and guidelines fordealing with acute situations


1a. Is able to recognise thespecific symptomsassociated with myeloma andits treatments

1b. Seeks out more experiencedhealthcare professionals foradvice and support if unsure

1. Communicates symptommanagement options clearlyto the patients and theirfamily

1a. Demonstrates expertise inassessing and recognisingsubtle changes in symptomsand initiates care

1b. Uses expert knowledge to assess, prioritise, treat and safely refer or dischargepatients with either treatment or myeloma-relatedside-effects

26



2. Communicates rationale forassessment clearly topatients

2. Initiates treatment accordingto clinical guidance and inconjunction with the MDT

2. Prioritises health problemsand intervenes appropriately,including initiation ofemergency care


1. Recognises the impact of thesymptoms on a patient’soverall wellbeing

1. Promotes participation in the treatment, managementand care of patients and carers

1a. Displays an ability to reassurepatients in a manner whichreduces anxiety

1b. Can relate theoreticalknowledge of myeloma to the patient

27



1. Develops and evaluates aself-management plan withthe patient to:

Maximise their quality of life

Promote rehabilitation

1. Develops ability to inform andteach patient techniques forself-care and about self-careto alleviate side-effects andmaximise their quality of life

1. Anticipates the effects ofclinical diagnosis on theindividual and family, adjuststreatment, management andcare to enhance wellbeing

2. Develops an understandingof the strategies patients useto facilitate self management

2. Specifically educates patientsabout risk of renalimpairment, infections andspinal cord compression

2. Uses expert knowledge to create and promotecreative and innovative self-management solutions to problems

3. Has an awareness of theimpact of myeloma on qualityof life

3. Discusses with the patientthe impact of myeloma onquality of life and makesrecommendations to manageside-effects with a view toincreasing quality of life

3. Develops or implementsquality of life measures orpatient-reported outcomes to inform service delivery

4a. Can explain the role ofvoluntary sector services inthe provision of advice andsupport to myeloma patients

4b. Ensures patients know about Myeloma UK or otherrelevant voluntary or patientorganisations and are awareof contact routes e.g. Infoline,website

4. Reinforces the supportvoluntary organisations likeMyeloma UK can provide topatients, their families andsignificant others

4. Works alongside thevoluntary sector and socialservices to ensure patientsreceive timely advice aboutbenefit helplines, andnational/local support groupsin written and verbal forms

5. Has an awareness of the roleof the allied healthcareprofessionals in therehabilitation of myelomapatients

5. Understands the localprocedures in place to refer apatient for rehabilitation andcan identify when a patientwould require referral

5. Contributes to research intothe use of exercise in therehabilitation of myelomapatients

6. Has knowledge of thenutritional and eatingproblems which impact onrecovery

6. Undertakes a nutritionalassessment of the patient

6a. Teaches high-risk patientgroups on the importance of a low microbial diet andmake dietaryrecommendations

6b. Where appropriate referspatient to a dietician

Core nursing competency 6: Self-management

28


7. Can explain to patients andtheir families/carers thedifferent methods ofinformation available formyeloma patients

7. Addresses the informationneeds of patients andprovides them withappropriate informationsources

7a. Evaluates the informationneeds of patients anddiscusses with patients andtheir families the usefulnessof the information

7b. Identifies gaps in patients’information needs andsources materials to addressthese gaps


1. Is able to discuss the impactof myeloma on the patient’squality of life

1. Provides information andexplanations to patients andtheir families to promote theirquality of life

1a. Prepares patients for the life-limiting nature of myeloma,adapting informationdependent on prognosis

1b. Is able to provide patients,their families and significantothers with information toinform them about risk ofrelapse/myeloma progression


1. Recognises the role of thewider multidisciplinary teamto encourage self-care

1. Promotes the role of bothstatutory and voluntarysectors as well as themultidisciplinary team in the provision of treatment,management and care topatients and their families

1. Evaluates the services of statutory and voluntarysectors and makesrecommendations aboutsupport services available to patients

29

Core nursing competency 7: Meeting holistic needs of patients



1. Demonstrates anunderstanding of holisticneeds, treatment phases,coping strategies andpsychosocial supportivemeasures

1. Assesses holistically,prioritises and plans care forpatients presenting withmyeloma irrespective ofhealthcare setting

1. Uses expert knowledge ofmyeloma to evaluate holisticneeds, to select and provideappropriate care

2. Demonstrates a knowledgeof the changing needs ofmyeloma patients at:

Diagnosis

Initial treatment

Follow-up

Transplant

Palliative care

End of life

2. Interprets the range of clinicaldata in relation to the phaseand type of treatment, toorder and facilitate timely and effective interventions

2. Initiates and accuratelyinterprets a wide range ofinvestigations withinguidelines and protocolsrelevant to myeloma care

3. Demonstrates understandingof the differing psychologicaland spiritual impact ondifferent myeloma groupsand their families

3. Uses a full range of nursingstrategies to relieve thepsychological and spiritualimpact of the physical andemotional consequences ofmyeloma upon the individual,family and friends

3. Has extensive knowledge of coping strategies andcrisis theories


1. Assesses the holistic needsof a myeloma patientincluding mental, social,cultural and spiritual issueswhich arise at different pointsalong the myeloma trajectory

1. Uses a structured approachto identify patient needs

1. Advises on expertmanagement, particularly indistressing circumstances

2. Demonstrates understandingof the treatment requirementsof different patient groupsbased on their clinical andsocial circumstances

2. Able to assess, plan andimplement treatment plans inconjunction with patientswishes and relevant to theirclinical and socialcircumstances

2. Develops specialisedprogrammes of care andhighly specialised advice,and can discuss in detailclinical trial information

Behaviour Behaviour Behaviour

1. Promotes an environment ofcare which is conducive toholistic nursing practice

1. Acts proactively as aneducator and resource aboutpatients’ holistic care needsto other professionals withinand outside the haematologysetting

1. Champions a holisticapproach to the treatment,care and management of patients working inpartnership with a range of service providers

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Core nursing competency 8: Continuity of care



1. Has understanding ofreferral/communicationroutes and pathwaysbetween primary andsecondary care

1a. Demonstrates the ability toaccess/use referralsystems/communicationroutes to optimise carebetween primary andsecondary care

1b. Accepts and generatesreferrals between primary andsecondary care, recognisingurgency and prioritisingpatient needs

1. Works in collaboration with all healthcare settings to ensure continuity of care is maintained

2. Demonstrates anunderstanding of the rolesand responsibilities primarycare providers have inprovision of treatment,management and care tomyeloma patients. Specificunderstanding is required ofthe role of GP, voluntarysector, community nursesand the level of servicesprovided to myeloma patients

2. Demonstrates the ability todiscuss a range of caresettings (GP, Social Services,community nurses, voluntarysector) with patients and offerappropriate advice to enablemyeloma patients to accessthese services

2. Is proactive in thedevelopment of protocols to enable staff at all levels to respond to myelomapatients and refer to theappropriate specialist

3. Demonstrates an awarenessof the impact of governmentagendas for the provision ofcare to myeloma patients:

Essence of care

Cancer Reform Strategy

End of life strategy

Haematology referralpathways

3. Has knowledge of the impactof other government agendasin the provision of care formyeloma:

Quality strategy

Patient safety agenda

3a. Has a working knowledge of the current political andhealthcare environmentaffecting decisions aboutcare

3b. Contributes strategically tolocal initiatives in response to the changing politicalenvironment


1. Able to assess and documentreferral details andinformation in a way which isclearly understood by primaryand secondary care with andwithout specialist knowledgeof myeloma

1. Coordinates referralpathways for patients withdiffering needs and plansinterventions accordingly

1. Monitors and evaluatesreferral pathways and qualityof referral information andliaises between primary andsecondary care

2. Contributes to meeting thenursing needs of patientsattending clinic

2. Coordinates patient clinics and is able to answer questions, provideinformation and support topatients and their families

2. Manages a case load of myeloma patients andnurse-led clinics, includingmanaging patients receivingtreatment in an outpatientsetting

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1. Discusses discharge planswith patients, their familiesand other healthcare/socialcare professionals in a clear manner

1. Develops tailored dischargeplans with input from theMDT based on the patient’sclinical and social factors

1. Audits the outcome ofdischarge plans to implementstrategies to avoidunnecessary readmissions

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Core nursing competency 9: Transplant management



1. Awareness of the rationaleand prognostic benefits ofusing transplants in the field of myeloma

1. Takes responsibility forleading a team, with the ability to organise, react andrespond to the treatment, management and care ofpatients during the pre andpost transplant phase

1. Aware of more complexaspects of transplant such as early signs of graft-versus-host disease (GVHD) andinfection and is capable of initiating appropriate action

2a. Understands the differenttypes of transplant used inmyeloma

2b. Has knowledge of high-dosetherapy, growth factors and immunosuppressivemedications

2a. Is able to discuss with thepatient and their family thetransplant process includingtheir hospital stay andrecovery period

2b. Discusses the stem cellcollection processes withpatients

2a. Has knowledge of screeningprocesses for potentialpatients, eligibility andspecific transplant processesincluding screening of donors for eligibility based on histo-compatibility (HLA typing)

2b. Is able to book relevantinvestigations

3. Has an understanding of themanagement of infectiouscomplications associatedwith compromised hostdefence mechanisms

3. Acts on clinical resultsindicating the presence ofinfections

3. Monitors transplant patientinfection rates


1. Provides care to transplantpatients under thesupervision of senior nursingand medical colleagues

1. Successfully managespatients undergoing stem cell transplant with skillsappropriate to intensivenursing care

1. Leads nursing input to thetransplant process

2. Has understanding of thecross-departmentaltreatment, management and care needs of patientsundergoing a transplant

2. Ability to act on changes and within the scope of themultidisciplinary team

2. Leads the transition of care to the community from thehospital for patients, liaisingwith their families and otherhealthcare professionalspost-transplant


1. Has understanding of the side-effects andcomplications of autologousand allogeneic stem celltransplants

1. Recognises complications of transplant including post-transplant infection, GVHDand long-term effects

1. Promotes and participates intransplant education

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Core nursing competency 10: Accountability for practice



1. Demonstrates an up-to-dateknowledge andunderstanding of myeloma

1a. Maintains learning andunderstanding throughparticipation in self directedlearning programmes on an ongoing basis

1b. Facilitates peer support

1. Is aware of futuredevelopments in myelomatreatment and contributes toresearch


1. Attends annual updates onmyeloma treatment, care andsupport

1. Participates in appropriateaudit and complies withguidelines

1. Uses expertise to informprotocol development andacts in a supervisory capacityfor other nurses


1. Shows a commitment toongoing training anddevelopment

1. Evaluates the care theyprovide and acts as aresource to other nurses in ensuring their care isevaluated against acceptedcompetencies, standards andguidelines

1. Acts as a local champion for continuing professionaldevelopment, appraisal andongoing learning anddevelopment

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Appendix I: Background to the FrameworkBackground to the Framework Myeloma UK identified that:

A myeloma-specific nurse competencyframework did not currently exist

There was growing evidence from patients,their families and carers in contact withMyeloma UK that there wereinconsistencies in myeloma care, treatmentand management across the UK

Feedback from nurses involved in theMyeloma Academy indicated that a nursingcompetency framework would be valued asa resource to set out required knowledge,skills and behaviour in myeloma treatment,management and care and to emphasisethe need for sustainable nursing roles in thefield of myeloma

As a consequence, Myeloma UK consideredthat this posed several risks whichdevelopment and implementation of thisFramework seeks to address:

Risks to patients of not receiving high-quality nursing care, which may impact on access to treatment, clinicaloutcomes and patient experience

Risks to nurses of operating within a fieldwhere they do not have sufficientknowledge or expertise or are unable tosustainably demonstrate their competency

Risks for the wider MDT and alliedhealthcare professionals of not havingaccess to a nurse specialist’s expertise for advice

Risks to Myeloma UK of increased pressureon our patient and family services as aresult of patients and families not receivingthe treatment, management and care theyrequire

Framework developmentThe Framework was developed by undertaking athorough literature search and review of bestpractice nurse guidelines applicable to myeloma,and other relevant national and local clinicalguidelines. A review of existing nursingcompetency frameworks, including theRCN/Dementia UK Admiral Nurses’ CompetencyFramework and the RCN CompetencyFramework for paediatric epilepsy nurse specialistservices was also undertaken.

We assembled an expert Myeloma NursingCompetency Framework review committee,(consisting of members with in-depth knowledgeand understanding of myeloma, experts in cancernursing and nurse education) to help develop anddefine myeloma-specific specialist nursingcompetencies.

The Myeloma Nursing Competency Frameworkreview committee included:

Eric Low OBE – Chief Executive, Myeloma UK

Sue Perkins – Service Development Manager,Myeloma UK

Lois Lobban – Healthcare ProfessionalProgrammes, Myeloma UK

Dr Judith Behrens – Consultant Haematologist

Dr Alastair Smith – Consultant Haematologist

Susan Blair – Haematology Day Unit Manager,The Christie Hospital, Manchester

Sophie Deppe – Macmillan Myeloma ClinicalNurse Specialist, King’s College Hospital,London

Joanne Tonkin – Haematology NurseConsultant, Colchester General Hospital,Colchester

Sue Cruickshank – Senior Lecturer/Reader inCancer Nursing, Edinburgh Napier University

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Framework contentThe Framework aims to support nurses torecognise, describe and demonstrate specificand measurable competencies and to identifythe additional skills and behaviours required tobecome more specialist in their role, with theaim of supporting continuous improvement inpatient care and nursing development.

The Framework defines myeloma-specificnursing specialist competencies, firmly centredaround the patients, and maps these againstthe NHS Knowledge and Skills Framework forBand 5, 6, 7 and 8 nurses. It includes corecompetencies for competent, experienced andspecialist nurses based on the Benner 9 modeland Royal College of Nursing (RCN) ThePrinciples of Nursing Practice17.

Framework audienceAlthough the Framework is a tool for nurses, ithas been developed with a patient-centredapproach and considers the broad myelomapatient population, their families and carers.The Framework is applicable to the treatment,management and care of all myeloma patients,irrespective of their race, gender, disability,sexual orientation, religion or age and as suchis compliant with the RCN’s Diversity Standardand Equality Impact Framework. It is alsoapplicable to patients at all stages of themyeloma pathway from diagnosis through toend of life.

We hope the Framework will also be ofrelevance to:

Other healthcare professionals, includingallied healthcare professionals who mayform part of the wider multidisciplinary team

Commissioners of myeloma treatment,management and care

Policy-makers

Core values underpinning theFrameworkMyeloma UK is committed to improving theinformation and emotional and practical supportto people affected by myeloma, and improving thestandard of treatment, management and carethrough research, education, campaigning andraising awareness.

The work of Myeloma UK is underpinned by aseries of core values put together by staff, theBoard and service users. They are of directrelevance to the Competency Framework:

1. LeadershipWe champion the importance of effectiveleadership and action. We are equipped with theknowledge of good governance. We encouragestaff initiative and leadership, and strive to be amodel organisation.

2. IntegrityWe adhere to high ethical and professionalstandards in our work and relationships. We arefair and respectful in our interactions and areconscientious stewards of the resources that areentrusted to us.

3. ExcellenceWe promote collaboration and partnership toleverage knowledge and skills to continuallyimprove our programmes and services for thebenefit of our stakeholders. Whether working inpartnership or independently, we endeavour toattain excellence in everything we do.

4. ImpactWe listen and understand the nature and needs ofour stakeholders and create tailored, strategicsolutions. We work closely with our stakeholders,partners and donors to achieve our objectives.

5. FocusWe are committed to ensuring that our work andits outcomes, and those of all our collaboratorsand partners, are firmly focused on patients, theirfamilies and carers.

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Appendix II: Monitoring and evaluation Ongoing reviewThe Competency Framework will be reviewedon an annual basis. This annual process willinclude stakeholder evaluation alongside anupdated literature review to ensure that theFramework remains clinically up-to-date and inkeeping with the NHS KSF dimensions, theRCN Principles of Nursing Practice andmyeloma policy and practice.

The annual evaluation will include feedbackfrom clinical nurse specialists using theFramework and a literature review to determinewhether any references or other content withinthe Framework needed to be updated. Usersare encouraged to contact Myeloma UK if theyhave any questions, queries or feedback onthe Framework as stipulated on The MyelomaAcademy website.

Feedback is sought from the three levels ofnurses outlined in the Framework (competent,experienced and specialist nurses) and clinicalsupervisors/medical mentors including nursesworking in a range of different healthcaresettings such as A&E, inpatient andoutpatients, community clinics and transplantservices.

Feedback will be monitored by the MyelomaUK Scientific and Medical EducationSpecialists on an ongoing basis and analysedas part of the annual review and evaluation ofthe Framework to ensure that it remainscurrent and reflective of UK clinical practice inmyeloma. Myeloma UK staff will be responsiblefor updating the Framework, in consultationwith the Nursing Competency FrameworkReview Committee.

The evaluation will focus on five key areas:

Structure and ease of use of Framework

Implementation

Clinical relevance

Patient experience of impact on quality of care

Identified areas for improvement

Use of the FrameworkThe Framework is available to download from theMyeloma UK website at www.myeloma.org.uk,which aims to adhere to W3C WCAG 1.0 level A.The Framework is free to download and it is alsoavailable in print by contacting Myeloma UK. Alarge print version of the Framework is availableon request.

All existing and future Intellectual Property Rights(IPR) (including without limitation, patents,copyright and related rights) of the MyelomaNursing Competency Framework belong toMyeloma UK. We are not aware of anyassociated conflicts of interest in the productionof this Framework. If conflicts of interest arise aspart of the implementation and evaluationprocess these will be assessed and addressed.

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References1. Cancer Research UK, Myeloma Key Facts, in Cancer Statistics Key Facts. 2014: London

2. Maddams, J. and H. Moller, One, Five and Ten Year Cancer Prevalence. 2010: London

3. Cerrato, C., R. Mina, and A. Palumbo, Optimal management of elderly patients withmyeloma. Expert Rev Anticancer Ther, 2014. 14(2): p. 217-28

4. Ludwig, H., et al., International Myeloma Working Group recommendations for globalmyeloma care. Leukemia, 2014. 28(5): p. 981-92

5. Snowden, J.A., et al., Guidelines for supportive care in multiple myeloma 2011. Br JHaematol, 2011. 154(1): p. 76-103

6. Royal College of Nursing, Competences: an education and training competence frameworkfor peripheral venous cannulation in children and young people. 2013, London: RCN

7. NHS Employers. Pay and reward/Nursing Services.pdf. 2006; Available from:http://www.nhsemployers.org/~/media/Employers/Documents/Pay%20and%20reward/Nursing_Services.pdf

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11. Donovan, K.A., et al., Validation of the Distress Thermometer worldwide: state of thescience. Psychooncology, 2014. 23(3): p. 241-50

12. Jacobsen, P.B., et al., Screening for psychologic distress in ambulatory cancer patients.Cancer, 2005. 103(7): p. 1494-502

13. Aaronson, N.K., et al., The European Organization for Research and Treatment of CancerQLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 1993. 85(5): p. 365-76

14. Cocks, K., et al., An international field study of the reliability and validity of a disease-specific questionnaire module (the QLQ-MY20) in assessing the quality of life of patientswith multiple myeloma. Eur J Cancer, 2007. 43(11): p. 1670-8

15. Osborne, T.R., et al., What issues matter most to people with multiple myeloma and howwell are we measuring them? A systematic review of quality of life tools. Eur J Haematol,2012. 89(6): p. 437-57

16. CEP, B.B.T. LearnBloodTransfusion. 2014; Available from: http://www.betterblood.org.uk

17. Royal College of Nursing. Principles of Nursing Practice. 2014; Available from:http://www.rcn.org.uk/development/practice/principles

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Bird, J.M., et al., Guidelines for the diagnosis and management of multiple myeloma. 2013, BritishCommittee for Standards in Haematology: London Available from:http://www.bcshguidelines.com/documents/MYELOMA_GUIDELINE_Feb_2014_for_BCSH.pdf

Snowden, J.A., et al., Guidelines for supportive care in multiple myeloma 2011. Br J Haematol, 2011.154(1): p. 76-103

Clinton-McHarg, T., et al., Anxiety and depression among haematological cancer patients attendingtreatment centres: prevalence and predictors. J Affect Disord, 2014. 165: p. 176-81

Carey, M., et al., Identifying psychological morbidity among people with cancer using the HospitalAnxiety and Depression Scale: time to revisit first principles? Psychooncology, 2012. 21(3): p. 229-38

Department of Health. The Essence of Care. 2010; Available from:https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216691/dh_119978.pdf

National Institute for Health and Clinical Excellence. Improving outcomes in haematological cancers:the manual. 2003; Available from: https://www.nice.org.uk/guidance/csgho/evidence/improving-outcomes-in-haematological-cancers-the-manual2

Royal College of Nursing. RCN Competences: Advanced nurse practitioners. 2012; Available from: http://www.rcn.org.uk/__data/assets/pdf_file/0003/146478/003207.pdf

Nursing and Midwifery Council. The Code: Standards of conduct, performance and ethics for nursesand midwives. 2008; Available from: http://www.nmc-uk.org/Documents/Standards/The-code-A4-20100406.pdf

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Myeloma UK22 Logie Mill, Beaverbank Business Park,Edinburgh EH7 4HGTel: 0131 557 3332 Email: [email protected] Charity No. SC 026116

This programme has been accredited by the RCN Centre for Professional Accreditation until 15 January 2016.Accreditation applies only to the educational content of the programme and does not apply to any product.