pens leadership - excemed
TRANSCRIPT
PENS
Leadership Kate Davies
Senior Lecturer in Children’s Nursing London South Bank University &
Research Nurse in Paediatric Endocrinology
Centre for Endocrinology, William Harvey Research Institute Barts and The London School of Medicine and Dentistry
Introduction • Paediatric Endocrine Nurse Roles
• Roles of Clinical Nurse Specialists
• Paediatric Endocrine Nurses Competency
Framework
• Advancing clinical roles
• Education for
paediatric
endocrine
nurses
• ESPEN
Paediatric endocrine nurse roles
• Patient education
• Patient / parent / family support
• Hands on nursing care
• Dynamic function tests
• Liasing / principle key worker within multidisciplinary
team
• Liaising with community teams / General
Practitioners
• Liaising with pharmaceutical industry
• Teaching
• Research
Clinical nurse
specialist
Consultant
Educator
Researcher
Collaborator
Leader
Change Agent
Patient
advocate
Liaison
Clinical Nurse Specialist roles
• Clinical Expert o Clinical knowledge
o How can your knowledge and skills within endocrinology be enhanced
• ? Further training / development
• Education o Sub-role as Educator
• Patients, families, staff
o Evaluate and develop educational programmes
o Build teaching packages for patient education
• GH devices / patient choice
• IM hydrocortisone
• CAH
• Puberty
Clinical Nurse Specialist roles
• Consultant o Leading on case management
o Becoming more involved in external forums
• Society committees
• Patient support groups
• Advisory boards
• Research o Identifying gaps within your clinical service which could use research /
audit
• Explore shortfalls
• Positive aspects
o Patient questionnaires
• Satisfaction in patient pathways
o Participation in clinical research
Clinical Nurse Specialist roles
• Patient advocate o Identify patient support groups not already utilised by your team
• Develop and strengthen links
o Enhance existing relationships
o Develop own patient literature
• Collaborator o Enhance collaboration within the MDT and interdisciplinary teams
• Ensure common purpose
o Working with other paediatric endocrine nurses
• UK / Europe / Worldwide
• Share best practice
o Pharmaceutical companies
o Community nurses
Clinical Nurse Specialist roles
• Leadership / Management o Lead in developing and attaining team goals
• Contribute to practice development
• Develop patient care pathways
o Sharing patient literature
• Change Agent o Provide evidence where CNS intervention could be useful
• Nurse led clinics
• Telephone clinics
• Innovative practice
o Suggest, develop and implement business
plans
Clinical Nurse Specialist as Change Agent
• Success of CNSs o Depends on their ability to develop their own support system
• Generate own job satisfaction
o Motivation
• Increased high output
o Negotiation
• = Change!
• Occurs at a slow pace
• ? Cost
o Need evidence for need for change
• ? Shortfalls in existing service
• ? Decreased patient satisfaction
(Llahana, 2005)
Advancing CNS roles • Using Change Agent concept
o Back up what you do
o Use this evidence to change practice
o Utilise frameworks to provide the evidence
o Explore educational pathways
• See how nursing care can be advanced
Nurse led care • Outpatients
o Nurse led clinics
o Telephone clinics
• Daycare o Nurse led dynamic investigations
o GH choice and training
o Emergency hydrocortisone training
o New referrals
o GnRH analogues
Benefits of nurse led care • Decreases patients’ waiting times
o Including the NLC
o GH prescribing process
• Increases doctors’ time in clinic for more complex
patients
• Building stronger relationships with patients and their
families
• Enhanced patient satisfaction
• Built upon recent competency
frameworks
Frameworks • Attempts have been made to put forward practice
frameworks for CNSs (Bamford & Gibson, 2000)
• No nationally recognised consensus guidelines for
competence standards for practising CNSs (Cattini & Knowles, 1999)
• Move forward over the last decade in competency
frameworks for nurses in specific specialities
RCN Competency Frameworks • 2004
o Paediatric Diabetes
• 2005
o Paediatric Epilepsy
o Aesthetic Medicine
o Occupational Health
o Ophthalmology
o Orthopaedic & trauma
• 2006
o Outpatients
• 2007
o In-flight nursing
o Travel health medicine
• 2008
o Paediatric Endocrinology
o ANPs
o Catheter care
o Parkinsons Disease
• 2009
o HIV-associated lipoatrophy in adults
o Sexual health
• 2010
o IVs, Cannulation, Venepuncture – CYP
• 2011
o Paediatric Cardiac nursing
o Menopause
o Finding, using & managing info
Endocrine nurse
competency frameworks • Focus on knowledge, skills and interventions specific
to endocrine nurses
• References local and national guidelines
• Adheres to Benner’s (1982) ‘Novice to Expert’
concept
• Benefits to three groups..
Groups that benefit from
competency frameworks • Nurses
o Deliver high standards of care
o Identifies your practice level
• Plan career in a stuctured way
o Pinpoint personal educational needs
o Realise potential
o Seize opportunities to influence the direction of nursing
• Employers o A model for higher care standards
o Clear insight into staff competence
o Assistance in organisational planning
• Patients o Providing higher standards of care
o Increased patient satisfaction
Paediatric Endocrinology
2008, 2013 • During period where
diagnosis is not yet reached
• Once diagnosis is confirmed
• Endocrine testing
• Transition
• Factors influencing growth
• Auxology
• Assessment of skeletal maturity
• Physiology and pathology
How it is used • As a tool to plan clinical aims and objectives
• For a personal development plan
• In the performance appraisal process o With reference to local guidelines and KSF
• Support job descriptions and pay reviews
• PEN – vast role o No same JD
o Not every competency relevant to each CNS
Specialist competencies Care of CYP with growth
and endocrine disorders
• During period where
diagnosis is not yet
reached
• Endocrine testing
• Once diagnosis is
confirmed
• Transition
Nursing considerations and understanding CYP
with growth and endocrine disorders
• Factors influencing
growth
• Auxology
• Assessment of skeletal
maturity
• Physiology and
pathology
During the period whilst diagnosis is not
yet reached
• Develop and ongoing relationship with the CYP and
family
• Empower the CYP and family to be actively
involved in managing their condition and making
decisions about treatment
• Refer to other agencies when appropriate eg
CAMHS, support groups
Once diagnosis is confirmed
• See CYP and family in nurse led clinic
• Discuss complex conditions and treatment regimens
• Takes into account educational, social and cultural
needs of the family when planning education and
support
• Develops written information for families and other
healthcare professionals
• Prescribe safely and cost effectively
Nurse led general paediatric endocrine
clinic in a general hospital – specialist
centre
Aims of NLC • Specific follow up for long term management
• More general patient education
• GH choice and start up
• Sick day management
• Patient education / compliance issues
• Alternate consultant appointments for less complex patients
• Precocious puberty management
• Appointment slots o 20 minutes o 40 minutes for new GH / sick day management training x2
• 8 appointments in one clinic session
Growth Hormone prescribing process
• Consultant decides to initiate GH → o Nurse Led clinic
• Go through understanding of condition • Side effects / adverse events
• Demo of GH devices: Patient choice • ? Indecisive
o DVDs / literature o Family to call CNS back o Another appointment offered
• Consultant writes to GP asking them to prescribe GH under a shared care protocol – copy also to the parents
• Once have decision of GH device from family, CNS contacts appropriate homecare team with patient info o Community nurse goes to patient’s home at a time convenient to them o Prescriptions through GP → homecare o Medication and equipment delivered to home
• GP discusses prescription with practice manager / PCT o Decides to prescribe or not o If no, prescribe from hospital CCG
• Whole process
o Approximately one month
Proformas for clinic • Premature adrenarche
• Premature thelarche
• PWS
• Turners syndrome
• CAH
• CPP
• Congenital
hypothyroidism
• GH administration
training
• GH choice
• IM HC training
• Panhypopituitarism
Nurse Led Clinics • Managerial support
o Huge issue
o Positive
o Increase revenue into the hospital
o Increased profile of nursing expertise / department
o Negative
o Room
o Admin
o Support
o Team issues
• Team support o Smooth liaison between medical and nursing personnel
• Consultants and junior Doctors
Professional Issues • Further education for NLC
o Advanced nursing practice
• Non medical prescribing course o Case study – Infant with CAH
o Bioequivalence of hydrocortisone tablets and suspension (Merke, 2001)
• Led on to further modules: o Advanced assessment of the presenting child
• Children’s Advanced Nurse Practitioner
• Continuing CPD o Revalidation
Enhanced care for the patients
Education for endocrine nurses - UK
• Paediatric
endocrinology o Auxology course
• Barts and The Royal
London Hospitalls
o BSc module
• Keele University
o BSc / MSc module
• London South Bank
University
o January 2017
• Adult endocrinology o Certificate in endocrine nursing
• Society of Endocrinology
o BSc / MSc distance learning
module
• Oxford Brookes University
o September 2016
Further training for advanced practice
• Advanced Nurse Practitioner o Non medical prescribing
o Advanced assessment skills
o Applied physiology
o Managing the complex presenting child
o Leadership and innovation
o Research
Children’s Advanced Nurse Practitioner
• 3 year MSc course
• Accredited by the RCN
• Specialising in specific fields
Course programme • Advanced assessment of the presenting child
• Principles of physiology
• Non medical prescribing
• Managing the complex presenting child
• Research
• Practice development
• Dissertation / work based project / systematic
review
Advanced assessment • History taking
• Examination of the infant, child and adolescent
• Physical assessment techniques o Inspection, palpation, percussion and auscultation
• Principles of anatomy, physiology and pathology o Respiratory and CXR interpretation
o Cardiac
o Neurological
o Abdominal
o Neonatal
o Head, Eyes, Ear, Nose and Throat
o Pain
o Mental health
o MSK
o Growth and development
Applied physiology • Brain development
• Management of raised ICP
• Endocrine physiology and growth and development
• Paediatric oncology
• The immune system
• Embryology
• Respiratory physiology
• The liver and metabolism
• Haematology
• Maturation of the renal system
• Physiology of the GI system
Non medical prescribing • Practical aspects of prescribing
o Clinical portfolio
• Practice log hours (75)
• Reflection (650 words) on Domains:
o The Consultation
o Prescribing effectively
o Prescribing in context
• 72 competencies to achieve
• Clinical management plan
• Prescription
• Prescribing in clinical practice o Clinical conditions
• History taking and differentials
o Written case study (3500 words)
o OSCE
• History taking and differential diagnosis
• Pharmacology and applied therapeutics o Pharmcological management of common conditions in all body systems
• Written exam
• Drug calculation exam
• OSCE
o Omeprazole, paracetamol, salbutamol, simvastatin, hydrocortisone cream, amxocillin
Non Medical Prescriber • Autonomous practitioner
• Able to prescribe from British National Formulary o Within field of competence
Managing the complex child • Principles of A&P
• Physical examination
• Models of problem solving
• Clinical decision making
• Indications for referral / how to
refer
• Pharmacological management
• Appropriate documentation of
findings
• Managing clinical uncertainty and complexity
Furthering education in
paediatric endocrinology • Auxology course – Barts and The London Hospitals
o Growth measurement
o Bone age reading
o Growth clinic
• BSc Module – Keele University
• BSc / MSc module – London South Bank University
Principles of care of the child and
young person in endocrinology
• Practice based assessment o Competency based booklet
• Diagnosis of endocrine disorders
• Management of endocrine emergencies
• Formative assessment o Group work
• GH scenario
• Summative assessment o Case study presentation
o BSPED approved
o January 2017
Module content • The endocrine system
• The multidisciplinary team
• Growth and the IGF-1 system
• Puberty
• Adolescent gynaecology
• Adrenal disorders o CAH o Cushings
• Disorders of Sex Development
• Thyroid disorders • Disorders of salt and water balance
• Pancreas disorders o Diabetes Types 1 and 2
• Bone metabolism and bone health
• Late effects of childhood cancers
• Hormone replacement treatment
• Advanced nursing roles in paediatric endocrinology
On completion.. • BSc in children’s nursing
o Old style training
• Pg Diploma in children’s nursing o Already have a degree
• MSc in children’s nursing o Clinical Nurse Specialist
ESPEN • Working group of Paediatric Endocrine Nurses
o ESPE Milan 2013
• ESPE Paris 2016 o European Society of Paediatric Endocrine Nurses officially formed
o Chair
• Christine Derycke, Belgium
o Vice Chair
• Andrew Dwyer, Switzerland
o Secretary
• Kate Davies, UK
Mission of ESPEN • To foster leadership and an ongoing tradition of
excellence in European paediatric endocrine
nursing care
• Best achieved through interprofessional
collaboration and by engaging stakeholders
including patients, families, patient support groups
and industry to promote health and quality of life for
patients with endocrine conditions.
ESPEN Aims • Promote coordinated interprofessional care for patients and
families with endocrine conditions
• Provide continuing education and professional development in paediatric endocrinology for nursing and allied health professions
• Collaborate internationally with the American and Canadian Paediatric Endocrine Nursing societies (PENS/CPENS) to promote excellence in nursing education, practice and research placing the patient and family at the center of holistic endocrine care.
• Employ evidence based approaches for developing, implementing and sharing best practices for paediatric endocrine nursing
• Develop tools and materials supporting paeditaric endocrine nursing that can be disseminated internationally
ESPEN next steps • Formalising group
o Finances
o Expanding committee
o Membership
• Exploring challenges o International stages of development
o Expand membership
o Share paediatric endocrine nursing best practice internationally
o Nurses presenting their own work: clinical / research
• Underscore nursing’s contribution to interprofessional care
• ESPE / International Meeting of Pediatric Endocrinology o International position statement on paediatric endocrine nursing
o Consensus statements
• Growth measurements
• Bullying
• Planning for ESPE Athens 2018
Conclusion • Introduction to varied role of the PENS
• Nurse led care
• Competency frameworks
• Education in the UK
• ESPEN
• Complements talk from
across the sea!
• Commence international collaboration
Further reading AUSTIN, L., LUKER, K. & RONALD, M. 2006. Clinical Nurse Specialists as entrepreneurs: constrained or liberated. Journal of Clinical Nursing, 15, 1540 -
1549.
AUSTIN, L., LUKER, K. & RONALD, M. 2006. Clinical Nurse Specialists and the practice of community nurses. Journal of Advanced Nursing, 54, 542 -
552.
DAVIES, K. & COLLIN, J. (2015) Understanding clinical investigations in children’s endocrinology Nursing Children and Young People, 27, 8, 26-36
HAMRIC, A. B. & SPROSS, J. A. (eds.) 1989. The Clinical Nurse Specialist in Theory and Practice, Philadelphia: W.B. Saunders Company.
LLAHANA, S. V. 2005. A Theoretical Framework for Clinical Specialist Nursing,
MARTIN, L. & COLLIN, J. 2015. An introduction to growth and atypical growth in childhood and adolescence. Nursing Children and Young People,
27, 29 - 37.
MCCREADDIE, M. 2001. The role of the Clinical Nurse Specialist. Nursing Standard, 16, 33 -38.
MCSHERRY, R., MUDD, D. & CAMPBELL, S. 2007. Evaluating the perceived role of the nurse consultant through the lived experience of healthcare
professionals. Journal of Clinical Nursing, 16, 2066 - 2080.
MILLER, S. 1995. The Clinical Nurse Specialist: a way forward? Journal of Advanced Nursing, 22, 494 - 501.
RCN 2005. Nurse practitioners: an RCN guide to the nurse practitioner role, competencies and programme approval. The Royal College of
Nursing.
RCN 2013. Competences: an integrated career and competency framework for children’s endocrine nurse specialists. London: Royal College of
Nursing.