document type: competency framework reference version …

Collated by Clinical Effectiveness Band 3 Core Competencies for Non-Registered Staff working inVersion 1 (March 2021) Stroke and Neuro-rehabilitation

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These competencies are designed for Band 3 staff working in multidisciplinary roles - if roles aremore specialist the staff members supervisor will work with the staff member to decide whichcompetencies are relevant.

Prior to accepting a patient, it is the joint responsibility of the RSW and trained therapist to agreea review or discussion date.

In all situations the RSW needs to report back immediately to the registered staff member if theobservations are not as expected.

Introduction

This competency framework is a learning and development resource for skilled non-registeredstaff working in stroke care and in neuro-rehabilitation. It should be used alongside the PersonalDevelopment Review process. The competencies have been designed to be flexible in order toaddress the differing learning needs and experience of users. Relevant areas of competenciesand the evidence in how they can be met should be identified as part of a development planbetween the staff member and their supervisor.

Competency framework aims: -

· To provide a consistent and high quality of care to service users· To ensure that staff who deliver care are competent to do so· To encourage training and share best practice across services· To provide a framework to monitor and guide practice

Using the framework

The framework is designed to be used as part of the review process. Staff should meet withtheir clinical supervisor to identify which of the competencies is relevant to their role, to reviewthe evidence of meeting the relevant competencies and identify priorities for learning with atimeframe for achievement.

In order to maintain competence the assessor must be confident in a person’s ability todemonstrate competence over time and in differing situations. Therefore, provision for

Document Type: Competency FrameworkReferenceNumber : 2295

VersionNumber: 1

NextReview Date: 30 September 2021

Title: Band 3 Core Competencies For Non-Registered Staff Working InStroke And Neuro-Rehabilitation

Document Author: Consultant Therapist

Applicability: As Indicated Below


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reassessment identifying achievement of learning in a chosen area and transference oflearning to other situations will be necessary.

Competencies should be signed off by the staff member’s supervisor or a registered staffmember. A brief record should be made of the forms of evidence used. These are expected toinclude observation of clinical work, discussions, evidence from clinical records evidence ofcompletion of CPD but also demonstration of application of training in practice.

All new staff should complete competencies within the first year. Thereafter the domains canbe used to supplement annual reviews.


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Domain Knowledge Skills Notes on evidence and signatures ofsupervisor and supervisee

Corecompetencies

Understand issues aroundconsent and mental capacity

To evaluate that the client is able toparticipate in an assessment ortreatment programme

To be able to gain appropriate consentfor treatment

To complete consent to shareinformation with the client on theassessment proforma

To establish that the client can followinstructions appropriately

To assess pain levels and how this mayimpact on the therapy session

Communication Have an understanding of thereasons for communicationdisability

Knowledge of StrokeAssociation (2012). Accessibleinformation guidelines: Makinginformation accessible forpeople with aphasia.

To enable people with communicationdisability to communicate using a rangeof resources

Collated by Clinical Effectiveness Band 3 – Competencies for Non-Registered Staff working in Stroke and Neuro-RehabilitationVersion 1 (March 2021) of 17


Vision To have an awareness of:

· Hemianopia, diplopia&visual inattention

· Difficulties in trackingand scanning

To have an awareness of thevisual pathway

To have an awareness of howvisual deficits can impactactivities of daily life

To have an awareness of visualscreening tests

To accurately feedback the effects of thevisual impairment in function and todiscuss this with the therapist

To conduct a basic visual screen(Balloon test) under direction/instructionof the therapist

To progress a vision programme underguidance of an OT

To observe, accurately record and liaisewith colleagues regarding problemsrelated to vision

To describe to patients and carers/familyhow stroke and neurological conditionscan cause visual difficulties



Cognition In association with patient safety,demonstrate an awareness ofcognitive skills

· Orientation in time and place· Short term/working memory· Attention/concentration· Sequencing· Problem solving· Insight and awareness· Initiation· Self-monitoring· Perseveration· Planning/organisationTo be aware what difficulties apatient can have with undertakingfunctional activities due tocognitive impairments

To have an awareness andunderstanding of the role of anOccupational Therapist inassessment and the treatment ofpatients with cognitive problems

To undertake a basic cognitive screen(eg MOCA) under instruction of an OT

To answer questions from the patientand carer/family relating to difficultiesresulting from changed cognition.

To understand when to refer complexquestions onto trained staff

To support a cognition programmeunder direction and supervision of anOT

To apply basic compensatorystrategies for cognitive impairmentswithin functional activities undersupervision of OT



Psychologicalsupport

Person is aware of thepsychological and emotionalproblems in people with strokeand neurological disability (e.g.depression, emotionalism,anxiety, self-esteem,confidence, well-being,challenging behaviour)

Person is aware of pathway forassessment and management ofpsychological difficulties forpeople with stroke andneurological disability, andservices available including peersupport service, StrokeAssociation, MS Society andother charities, Improvingaccess to psychologicaltherapies and support providedby members of the team

Person is aware of supportservices for carers

To recognise the signs, symptoms andimpact of psychological and emotionalproblems in people with stroke andneurological disability (e.g. depression,emotionalism, anxiety, self-esteem,confidence, well-being, challengingbehaviour), and report back to registeredstaff

To undertake basis assessments ofmood on instruction (such as Signs ofDepression scale, PHQ9, GADS7) andreport findings

To demonstrate listening skills andempathy with patients at all times

To recognise the signs, symptoms andimpact of psychological and emotionalproblems in carers and report back toregistered staff

To have a working knowledge ofresources to support self-managementsuch as the peer support service orDepression and anxiety service and beable to inform patients and carers.



Physicalrehabilitation-motor

Have an understanding of theimpact of weakness, reducedrange of movement andabnormal muscle tone onmovement

To carry out an appropriate subjectiveassessment

To assess the range of movement in themajor joints

To carry out Oxford Muscle Testing toassess muscle strength

To identify abnormal muscle tone

To know the importance of raisingconcerns to the appropriate professional.



Physical-sensation

To be aware of possible changes insensation in stroke and neurologicalconditions and how this may impact onmobility

To be aware of the risks of skindamage and injury if there are changesin sensation

To demonstrate a working knowledge ofthe signs and symptoms of pressuredamage

To observe for signs of pressure damageand refer to the appropriate professionalwhen indicated

Physical- gait Understand a normal walking patternand normal gait parameters such ase.g. stride length , foot clearance andbase of support

To be aware of common gaitabnormalities in people with stroke andneurological conditions

To know and instruct on the correct use ofwalking aids such as frames and sticks

To carry out a timed walk test whenrequested

Physical-balance

To be aware of normal systems thatcontribute to postural control: toinclude; musculoskeletal;neuromuscular and sensory

To identify balance problems andhighlight these to the physiotherapist

To carry out a Berg Balance test

To follow and progress a balance exerciseprogramme prescribed by thephysiotherapist



Physical-progression ofexercises

To be aware of the importance ofexercise for strengthening,endurance and flexibility

Have an awareness of othertreatments for physical rehabilitationincluding mental rehearsal, andconstraint induced movementtherapy

To ensure patients have written/illustrated copies of exercise programmes

To increase the number of repetitions ofexercises following discussion with thetherapist

To supervise and progress an exerciseprogramme including strengthening andbalance exercises and functional practice

Recognise when patients may be suitablefor other treatments such as mentalrehearsal, and constraint inducedmovement therapy and refer on asappropriate

Physical- use ofsplints

Understand the rational for the use ofsplints

To recognise when the patient’s limbs arebecoming tighter or more supple andfeedback concern about fit of splints totherapist

To don/doff a splint,

To instruct carers how to don/doff and carefor a splint

To support the patient and carer infollowing a regime for wearing the splint asadvised by the therapist.



Social care andequipment

Demonstrate a workingknowledge of the Care Act 2014

Demonstrate an understanding ofcharges for services

Complete appropriate training asidentified by supervisor

To have a working knowledge ofindicators that carers areexperiencing difficulty withmanual handling or that unsafetechniques are in use

Demonstrate an awareness ofsafeguarding issues andprocesses

Demonstrate knowledge of, andprovide information to patientsand carers about services andsupport beyond the communityneuro team

To have an awareness ofcommon adaptations and telecare

To complete consent to share informationwith the client on the assessment proforma

To order , fit and demonstrate equipmentfollowing instruction of therapist

To identify where there may be a changeneeded in packages of care and report thisto the appropriate professional.

To identify and report back to theappropriate professional immediately withany concerns.

To ensure accurate use of documentationincluding the manual handling plan. (eg isin place, in date, signed etc) .

To identify and report back to theappropriate professional immediately withany Safeguarding concerns.

To contribute to safeguarding meetings

To identify needs for adaption/telecare to theappropriate professional.



Working in ateam

Understand the stroke pathwayUnderstand other pathways forpeople with other neurologicalconditionsUnderstand how people arereferred to and discharged fromthe service

To accept referrals and know how to passthese onto the appropriate professional fortriaging

To communicate appropriately with allmembers of the MDT

Working withcarers

Recognises risk factors to carersand informs the registeredpractitioner

To demonstrate a specific set of exercises,stretches or positioning.

To demonstrate to carers how to assist aperson to walk when it is appropriate to doso.

Working withstudents

To work in the patient’s home environmentwith the support of the student for a jointsession. The session should not exceed thecompetency of the band 3 who isresponsible for the care delivered.



Communicationtherapy

(for workerssupporting speechand languagetherapyprogrammes)

Understands the nature and processof normal communication.

Demonstrates knowledge ofcommunication disorders indiscussion with the SLT.Right and left hemispheredysphasia.Dyspraxia.Dysarthria.Dyslexia.Dysgraphia.Cognitive communicationimpairment.

Understands the inter -relationshipbetween language, attention,memory, praxis and executive skills.

Understands the implications ofimpairment in motor planning,muscle weakness , tone andsensory loss.

Understands the SLT pathway, roleand contribution to the MDT.

Has a working knowledge of theAccessible information guidelines[Stroke association 2012]

To be able to use a range of communicationmodalities for total communication.

Communicates with patients in a mannerconsistent with their level of functioning.

To be able to accurately describe the effects ofStroke and neurological disorders oncommunication with relevant terminology.

To effectively use communication strategiesrelated to cognitive communication impairment.

To be able to describe and carry out supportivestrategies and prompting for; AAC.Writing.Gesture.Positioning to optimize communication

Is able to ensure that each person withcommunication problems is made known to theSLT service and has communication advice.

Is able to provide visual and written informationunder the guidance of the SLT in a personspecific manner.



Communicationtherapy

continued

Demonstrates an understandingof how communication disorderscan affect activities of daily livingand social interaction throughdiscussion with SLT.

Demonstrates an understandingof screening tools for oromotorand communication impairmentin discussion with the SLT.

Demonstrates an understandingof rating scales and theirfunctions.

To undertake observation ofSLTs working with patients withcommunication impairments andtheir specific therapyprogrammes.

Demonstrates knowledge ofgroup dynamics throughobservation and discussion withthe SLT.

Demonstrates an understandingand use of technology to assistSLT therapy programmes.

Is able to apply alternative and supportivecommunication strategies.

Is able to describe to patients , carers andfamily how stroke and neurologicalconditions can affect communication.Is able to recognise complex questionswhich require referral back to the SLT.

Is able to carry out basic screeningassessments and collect information forassessment purposes.

Is able to use a variety of rating scales toscale deficit levels, feelings, and progress.

To be able to support and carry outcommunication therapy programmes underthe direction and supervision of the SLT.

To progress programmes under theguidance of the SLT.Programmes will include;A] Enabling function i.e. introduction ofstrategiesB] Improving function i.e. semanticfacilitation.C] Compensates e.g. environmentaladaptation.


D] Increases participation e.g. supportedcommunication and AAC.E] Supports communication partners withperson specific strategies.Is able to run and manage small socialgroups to reinforce skills related to SLTgoals.Is able to run and manage small impairmentspecific groups related to SLT therapyprogrammes

Is able to carry out computer/Ipad SLTprogrammesIs able to use communication aids.



Swallowing

Skill level -STAGE ONE:INFORMATIONGATHERINGANDOBSERVATION

To have an understanding of:Normal swallow processDysphagia – causes andconsequencesDysphagia – Follow dysphagiamanagement plans

Understands the relevance ofan oromotor examination (hasobserved SLT conducting aclinical eating and swallowingassessment)

Understands the importance ofinvolving patients and carers(has observed SLT givingfeedback to patient and/orrelatives)

Understand the importance ofMDT approach in managingdysphagia (has observed othermembers of MDT supportingpatients)

Has a working knowledge ofthe risk management andethical considerations indysphagia

To take a case history - informationextracted from medical notes andfrom discussion with relevantprofessionals and carers*See A. Information points toconsider

To recognise a range nutritionalsupplements and modified diets

To appropriately and competentlythicken drinks

To observe patient at mealtime andat rest, reporting immediately anychoking or distress

Effectively uses cervical auscultation



Swallowing

Skill level -STAGE TWO:ACTIVEINVOLVEMENTUNDERSUPERVISION


Understand the impact of beingfed by others and of feedingothers (via attendance atexperiential workshop)

Understand swallowing therapy(by observation of SLTconducting this)

To take case history from patient

To actively participate in theassessment conducted by Speech andLanguage Therapist and subsequentmanagement plan

To write Speech and LanguageTherapy and/or other appropriateclinical notes*See C. Points to consider regardingdocumentation



Swallowing

Skill level - STAGETHREE: HANDS ONDYSPHAGIAMANAGEMENT


To contribute to discussion aboutmanagement of dysphagia givingappropriate consideration to ethicaland risk management issues

To contribute to the dysphagia planregarding postures vs. manoeuvres vs.therapy in dysphagia management ofpatient

Swallowing

Skill level -STAGE FOUR:HANDS ONWITH DISTANTSUPERVISION


To competently feed back at MDTmeeting / ward round regardingpatient’s performance

To follow dysphagia managementplans*See D. Points to consider regardingimplementation of dysphagiamanagement plan

To competently demonstrateprogramme to patient/carer.

To competently feed back to patients,carers or relatives.

To carry out swallow therapyprogramme as prescribed by clinician

Collated by Clinical Effectiveness Band 3 – Core Competencies for Non-Registered Staff working in Stroke and Neuro-Version 1 (March 2021) Rehabilitation

Document Control Information


This is a controlled document and should not be altered in any way without the expresspermission of the author or their representative.

Please note this document is only valid from the date approved below, and checks shouldbe made that it is the most up to date version available.

If printed, this document is only valid for the day of printing.

This guidance has been registered with the Trust. The interpretation and application ofguidance will remain the responsibility of the individual clinician. If in doubt contact a seniorcolleague or expert. Caution is advised when using clinical guidance after the review date,or outside of the Trust.

Have you identified any issues on the Rapid (E)quality ImpactAssessment. If so please detail on Rapid (E)QIA form. Yes ☐

Please selectYes No

Does this document have implications regarding the Care Act?If yes please state: ☐ ☐

Does this document have training implications?If yes please state: ☐ ☐

Does this document have financial implications?If yes please state: ☐ ☐

Ref No: 2295

Document title: Band 3 Core Competencies For Non-Registered Staff Working InStroke And Neuro-Rehabilitation

Purpose of document: Competency FrameworkDate of issue: 13 April 2018 Next review date: 30 September 2021Version: 1 Last review date: 22 January 2021Author: Consultant TherapistDirectorate: Allied Health ProfessionalsEquality Impact: The guidance contained in this document is intended to be

inclusive for all patients within the clinical group specified,regardless of age, disability, gender, gender identity, sexualorientation, race and ethnicity & religion or belief

Committee(s)approving thedocument:

Head of Physiotherapy/Interim Head of OT & General ManagerMSK Services

Date approved: 10 April 2018Links or overlaps withother policies:



Is this document a direct replacement for another?If yes please state which documents are being replaced: ☐ ☐

Document Amendment History

DateVersion

no.Amendment

summary Ratified by:13 April 2018 1 New Head of Physiotherapy/Interim Head of

OT & General Manager MSK Services19 March 2021 1 Review Date

ExtensionConsultant Therapist


The Mental Capacity Act

The Mental Capacity Act 2005

The Mental Capacity Act provides a statutory framework for people who lack capacity tomake decisions for themselves, or who have capacity and want to make preparations for atime when they lack capacity in the future. It sets out who can take decisions, in whichsituations, and how they should go about this. It covers a wide range of decision makingfrom health and welfare decisions to finance and property decisions

Enshrined in the Mental Capacity Act is the principle that people must be assumed to havecapacity unless it is established that they do not. This is an important aspect of law that allhealth and social care practitioners must implement when proposing to undertake any actin connection with care and treatment that requires consent. In circumstances where thereis an element of doubt about a person’s ability to make a decision due to ‘an impairment ofor disturbance in the functioning of the mind or brain’ the practitioner must implement theMental Capacity Act.

The legal framework provided by the Mental Capacity Act 2005 is supported by a Code ofPractice, which provides guidance and information about how the Act works in practice.The Code of Practice has statutory force which means that health and social carepractitioners have a legal duty to have regard to it when working with or caring for adultswho may lack capacity to make decisions for themselves.

All Trust workers can access the Code of Practice, Mental Capacity Act 2005 Policy,Mental Capacity Act 2005 Practice Guidance, information booklets and all assessment,checklists and Independent Mental Capacity Advocate referral forms on ICON.

https://icon.torbayandsouthdevon.nhs.uk/areas/mental-capacity-act/Pages/default.aspx

Infection Control

All staff will have access to Infection Control Policies and comply with the standards withinthem in the work place. All staff will attend Infection Control Training annually as part oftheir mandatory training programme.

“The Act is intended to assist and support people who maylack capacity and to discourage anyone who is involved incaring for someone who lacks capacity from being overlyrestrictive or controlling. It aims to balance an individual’sright to make decisions for themselves with their right to beprotected from harm if they lack the capacity to makedecisions to protect themselves”. (3)

https://icon.torbayandsouthdevon.nhs.uk/areas/mental-capacity-act/Pages/default.aspx


Rapid (E)quality Impact Assessment

Rapid (E)quality Impact Assessment (EqIA) (for use when writing policies)

Policy Title (and number) Version and DatePolicy AuthorAn (e)quality impact assessment is a process designed to ensure that policies do not discriminate or disadvantage peoplewhilst advancing equality. Consider the nature and extent of the impact, not the number of people affected.Who may be affected by this document?Patients/ Service Users ☐ Staff ☐ Other, please state… ☐

Could the policy treat people from protected groups less favourably than the general population?PLEASE NOTE: Any ‘Yes’ answers may trigger a full EIA and must be referred to the equality leads belowAge Yes ☐ No☐ Gender Reassignment Yes ☐ No☐ Sexual Orientation Yes ☐ No☐Race Yes ☐ No☐ Disability Yes ☐ No☐ Religion/Belief (non) Yes ☐ No☐Gender Yes ☐ No☐ Pregnancy/Maternity Yes ☐ No☐ Marriage/ Civil Partnership Yes ☐ No☐Is it likely that the policy could affect particular ‘Inclusion Health’ groups less favourably than the generalpopulation? (substance misuse; teenage mums; carers1; travellers2; homeless3; convictions; social isolation4;refugees)

Yes ☐ No☐

Please provide details for each protected group where you have indicated ‘Yes’.

VISION AND VALUES: Policies must aim to remove unintentional barriers and promote inclusionIs inclusive language5 used throughout? Yes ☐ No☐ NA ☐

Are the services outlined in the policy fully accessible6? Yes ☐ No☐ NA ☐

Does the policy encourage individualised and person-centred care? Yes ☐ No☐ NA ☐

Could there be an adverse impact on an individual’s independence or autonomy7? Yes ☐ No☐ NA ☐

EXTERNAL FACTORSIs the policy a result of national legislation which cannot be modified in any way? Yes ☐ No☐What is the reason for writing this policy? (Is it a result in a change of legislation/ national research?)

Who was consulted when drafting this policy?Patients/ Service Users ☐ Trade Unions ☐ Protected Groups (including Trust Equality Groups) ☐

Staff ☐ General Public ☐ Other, please state… ☐

What were the recommendations/suggestions?

Does this document require a service redesign or substantial amendments to an existing process? PLEASENOTE: ‘Yes’ may trigger a full EIA, please refer to the equality leads below

Yes ☐ No☐

ACTION PLAN: Please list all actions identified to address any impactsAction Person responsible Completion date

AUTHORISATION:By signing below, I confirm that the named person responsible above is aware of the actions assigned to themName of person completing the form SignatureValidated by (line manager) Signature


Rapid (E)quality Impact Assessment

Please contact the Equalities team for guidance:For Devon CCG, please email [email protected] & [email protected]

For Torbay and South Devon NHS Trusts, please call 01803 656676 or email [email protected] form should be published with the policy and a signed copy sent to your relevant organisation

Consider any additional needs of carers/ parents/ advocates etc, in addition to the service user2 Travelers may not be registered with a GP - consider how they may access/ be aware of services available to them3 Consider any provisions for those with no fixed abode, particularly relating to impact on discharge4 Consider how someone will be aware of (or access) a service if socially or geographically isolated5 Language must be relevant and appropriate, for example referring to partners, not husbands or wives6 Consider both physical access to services and how information/ communication in available in an accessible format7 Example: a telephone-based service may discriminate against people who are d/Deaf. Whilst someone may be able to act on theirbehalf, this does not promote independence or autonomy

mailto:[email protected]



Collated by Clinical Effectiveness Band 3 – Core Competencies for Non-Registered Staff in Stroke andVersion 1 (March 2021) Neuro-Rehabilitation

Clinical and Non-Clinical Documents – Data Protection

Clinical and Non-Clinical Policies – Data Protection

Torbay and South Devon NHS Foundation Trust (TSDFT) has a commitment to ensurethat all policies and procedures developed act in accordance with all relevant dataprotection regulations and guidance. This policy has been designed with the EU GeneralData Protection Regulation (GDPR) and Data Protection Act 2018 (DPA 18) in mind, andtherefore provides the reader with assurance of effective information governance practice.

The UK data protection regime intends to strengthen and unify data protection for allpersons; consequently, the rights of individuals have changed. It is assured that theserights have been considered throughout the development of this policy. Furthermore, dataprotection legislation requires that the Trust is open and transparent with its personalidentifiable processing activities and this has a considerable effect on the way TSDFTholds, uses, and shares personal identifiable data.

Does this policy impact on how personal data is used, stored, shared or processed in yourdepartment? Yes ☐ No ☐

If yes has been ticked above it is assured that you must complete a data mapping exerciseand possibly a Data Protection Impact Assessment (DPIA). You can find more informationon our GDPR page on ICON (intranet)

For more information:· Contact the Data Access and Disclosure Office on [email protected],· See TSDFT’s Data Protection & Access Policy,· Visit our Data Protection site on the public internet.

https://icon.torbayandsouthdevon.nhs.uk/areas/gdpr/Pages/default.aspx


https://icon.torbayandsouthdevon.nhs.uk/areas/information-governance/Policies/TSDFT%20Policy%20Data%20Protection%20and%20Access.pdf

https://www.torbayandsouthdevon.nhs.uk/about-us/data-protection/