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› �Why�we�need�a�Stroke-Specific�Education�Framework

› �Task�Groups�and�the�Stroke�Pathway

› Who�should�use�the�SSEF?

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Project team and contributors

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STROKE-SPECIFICEducation Framework



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IntroductionHigh-quality�care�and�services�for�people�with�stroke�need�to�be�delivered�by�staff�with�appropriate�knowledge�and�skills.�Currently�there�is�no�co-ordinated�strategic�approach�to�workforce�development�through�education�and�training.

A new strategy and education frameworkAt�the�UK�Stroke�Forum�in�2007,�it�was�agreed�that�a�new�UK-wide�Forum�for�Stroke�Training�should�be�created�to�support�the�development�of�high�quality�stroke�services�and�provide�information�on�how�stroke�care�should�be�delivered�and�by�whom.�It�would�consist�of�a�Steering�Group�supported�by�four�Task�Groups.�A�Stroke-Specific�Education�Framework�(SSEF)�would�be�developed,�which�would�be�a�fundamental�first�step�in�establishing�transferable�education�and�learning�programmes�in�stroke.

©�UK�Forum�for�Stroke�Training�2010

The�text�of�this�document�may�be�reproduced�free�of�charge�for�non�commercial�use�in�any�format�or�medium�providing�that�it�is�reproduced�accurately�and�not�in�a�misleading�context.

The�material�must�be�acknowledged�as�UK�Forum�for�Stroke�Training�copyright�and�the�document�title�specified.�Where�third�party�material�has�been�identified,�permission�from�the�respective�copyright�holder�must�be�sought.



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Why we need a Stroke-Specific Education Framework The�overall�purpose�of�the�Stroke-Specific�Education�Framework�(SSEF)�is�to�create�UK-recognised,�quality�assured�and�transferable�standards�for�stroke�training.�It�will�also�outline�stroke-specific�knowledge�and�skills�which�need�to�be�added�to�the�generic�skills�that�health,�social,�voluntary�and�independent�care�staff�already�possess.

Stroke�care�can�be�divided�into�16�elements�of�care�that�span�the�whole�Stroke�Pathway.


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The Stroke Pathway

First contact Treatment andrehabilitation

Prevention Long-term support andreview

5 Assessment (TIA) 6 Treatment (TIA)

7 Urgent response

8 Assessment (stroke) 9 Treatment (stroke)

10 High-quality specialistrehabilitation 11 End-of-life care

12 Seamless transfer of care

13 Long-termcare and support

15 Participationin community life

14 Assessment andreview

16 Return to work

4 Involving individuals in developing services

3 Information, advice and support

1 Awareness raising

2 Managing risk

Stroke-Specific Education Framework

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› �Task Groups and the Stroke Pathway


Task Groups and elements of careThere�were�four�Task�Groups�in�the�UK�Forum�for�Stroke�Training,�with�an�overarching�Steering�Group.�The�Task�Groups,�as�well�as�the�Steering�Group,�had:l� explicit�representation�from�relevant�professional�bodies�(stroke-specific�and�

stroke-relevant);�health�and�social�care;�and�voluntary�organisations;l� involvement�of�people�who�have�had�a�stroke;�andl� representatives�from�England,�Wales,�Scotland�and�Northern�Ireland.

Each�Task�Group�developed�key�aspects�of�the�Stroke-Specific�Education�Framework�(SSEF)�around�specific�elements�of�care.�The�elements�of�care�they�were�responsible�for�were:l� Awareness�and�Information�(1–4);l� Time�is�Brain�(5–9);l� Life�After�Stroke�(10–16);�andl� Implementation�(consideration�of�the�future�development�and�embedding�of�the�SSEF�in�

the�workforce,�including�endorsement).


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Implementation Task GroupThis�Task�Group�guided�the�process�of�Stakeholder�Engagement,�targeting�individuals�and�organisations�likely�to�use�the�SSEF.�The�Implementation�Task�Group�made�recommendations�about�how�to:l� avoid�duplication�by�linking�the�SSEF�to�existing�resources�(e.g.�National�Library�for�Stroke,�

UK�Stroke�Forum),�or�forthcoming�bodies;l� link�the�SSEF�to�other�frameworks�(e.g.�for�long-term�conditions);l� ensure�that�the�SSEF�remains�up�to�date,�useful,�used�and�continually�supported;l� establish�a�process�to�update�the�SSEF�in�line�with�changes�in�treatment�and�new�research�

evidence;l� include�the�whole�of�the�Stroke�Pathway�within�the�scope�of�the�SSEF;�andl� ensure�that�feedback�and�audit�are�in�place�to�evaluate�whether�the�SSEF�is�making�a�

difference�in�service�quality.�


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› Who should use the SSEF?

Who should use the Stroke-Specific Education Framework?The�Stroke-Specific�Education�Framework�(SSEF)�will�offer�UK-recognised,�quality-assured,�transferable�learning�programmes�in�stroke�at�all�levels.

It�is�for�people�or�groups�who�provide�stroke-specific�training�and�those�working�in�health,�social,�voluntary�and�educational�services�who�are,�or�who�are�likely�to�be,�in�contact�with�people�who�have�had�a�stroke�or�a�Transient�Ischaemic�Attack�(TIA).�

>� Stroke-specific�and�stroke-relevant�professional�bodies>� Course�designers>� Commissioners�of�services�for�those�affected�by�stroke>� Health,�social,�voluntary�and�independent�sector�organisations>� People�who�are�likely�to�be�looking�for�a�suitable�course�or�training�in�stroke>� Independent�providers�of�enhanced�services

The�SSEF�has�been�designed�for�people�to�have�easy�access�to�information�around�each�of�the�elements�of�care�in�the�stroke�pathway.��As�such,�it�is�envisaged�that�whoever�uses�the�SSEF�will�dip�into�the�sections�relevant�to�them.��The�SSEF�has�not�been�designed�to�be�read�like�a�book�from�cover�to�cover.


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Groups who may find this Stroke-Specific Education Framework a useful resource

Stroke-specific and stroke-relevant professional bodiesProfessional�bodies�related�to�the�NHS�promote�recognised�training�and�qualifications�and�ensure�quality.�They�can�endorse�training�courses�that�provide�knowledge�and�skills�in�keeping�with�the�SSEF.

Course designersUsing�the�SSEF�when�designing�courses�will�notonly�offer�quality�assurance�and�accreditation,�but�also�increase�training�opportunities�for�education�providers.�If�a�course�is�planned,�or�has�already�been�developed,�that�includes�information�about�stroke�and�TIA�then�the�SSEF�will�demonstrate�the�type�of�knowledge�and�skills�that�should�be�included�in�the�

�

curriculum.�The�course�designer�will�be�able�to�decide�on�the�level�of�knowledge�and�understanding�that�is�appropriate�for�their�students�and�target�audience.�

Commissioners of services for those affected by strokeIn�meeting�quality�standards�in�NHS�contracts,�commissioners,�e.g.�local�authorities,�primary�care�trusts�(PCTs),�third�sector�organisations�and�practice-based�commissioners,�should�recognise�the�need�for�improving�skills�in�the�stroke�workforce.�Using�the�SSEF,�they�can�ensure�that�service�providers�have�staff�with�appropriate�training.�A�consequence�of�this�is�that�elements�of�their�service�(e.g.�the�Stroke�Unit)�could�also�become�quality�assured.�This�could�be�applied�to�both�private�and�public�providers�of�services.


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IntroductionHealth, social, voluntary and independent sector organisationsEstablishing the SSEF means that both voluntary and paid staff can be given the best training at an appropriate level for the service they are providing. Having proven competences could ensure that their remuneration is commensurate with their knowledge and skill level. For employers, when developing job plans and recruiting, it will be possible to stipulate the qualifications required, based on the SSEF.

People who are likely to be looking for a suitable course or training in strokeTo develop skills for working in stroke it is critical that courses provide appropriate training. The SSEF can be used to determine if the content of a course is comprehensive and meets an individual’s training needs. Such courses will be consistent, transferable and recognised across organisations. As such, the SSEF can be used by anyone who works on the Stroke Pathway at any level. Individuals will be able to demonstrate that they have the appropriate competences for their level or to meet qualifications in job advertisements – and if they further their level of knowledge and understanding they will be able to use the SSEF to develop their careers. Within the SSEF, the knowledge and understanding required at different levels can vary from basic to critical, which means it can be used by both specialists or generalists and support individuals who want to take on advanced roles.


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�

Independent providers of enhanced servicesThe�SSEF�can�be�used�to�ensure�that�employees�have�the�right�training�for�the�service�they�provide.�Moreover,�it�can�be�used�to�show�commissioners�that�employeesprovided�by�third�parties�have�appropriate�training.


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References1.�Department�of�Health�(2007)�National Stroke Strategy2. Department�of�Health�(2004)�The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process

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GlossaryConcordance –�The�agreement�between�a�patient�and�a�healthcare�professional�about�thefrequency,�amount�and�duration�of�treatment�(e.g.�medication,�therapy).

�

Commissioners�–�primary�care�trust/health�boards�that�have�the�responsibility�for�contracting�the�right�services�for�their�community�and�providing�links�with�GPs�and�social�services.

Early�–�the�first�72�hours�after�stroke�onset.

Haemorrhage�–�a�stroke�caused�by�a�bursting�of�blood�vessels�producing�bleeding�into�the�brain,�which�causes�damage.

Independent sector�–�private�organisations�providing�care�and�treatment.

Ischaemic�–�the�most�common�form�of�stroke�(85%),�caused�by�a�clot�narrowing�or�blocking�blood�vessels�so�that�blood�flow�is�reduced�to�some�areas�of�the�brain,�which�leads�to�the�death�of�brain�cells�due�to�lack�of�oxygen.

Mental capacity�–�The�ability�to�make�a�decision�for�one’s�self�in�relation�to�the�matter�at�hand.

*Mental Capacity Act –�‘An�Act�to�make�new�provision�relating�to�persons�who�lack�capacity’.


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Professional�–�is�used�to�reflect�professionalism�rather�than�to�indicate�certification�or�licensing.�Therefore,�the�term�professional�relates�to�a�person�respecting�others�and�considering�confidentiality,�dignity�and�culture.

Third sector�–�a�collective�term�of�neither�public�nor�private�organisations�i.e.�organisations�that�are�non-governmental,�are�value-driven�and�which�principally�reinvest�surpluses�in�the�organisation�or�the�community.�This�includes�all�organisations�that�would�define�themselves�as�voluntary�and�community�organisations,�charities,�social�enterprises,�mutuals�or�co-operatives.�

Those affected by stroke�–�can�mean�the�patient,�carer,�relatives,�friends�or�society.

Transient Ischaemic Attack (TIA) –�sometimes�also�known�as�a�minor�stroke,�in�which�symptoms�of�a�stroke�subside�within�24�hours.�

UK Forum for Stroke Training�–�a�UK-wide�organisation�that�supports�the�National�Stroke�Strategy�and�provides�information�on�how�stroke�care�should�be�delivered�and�by�whom.

Voluntary sector –�charities�and�the�wider�not-for-profit�organisations.�

Workforce�–�is�any�group�of�people�who�may�provide�service�or�input�for�stroke�patients,�and�so�includes�health,�social�services�and�voluntary�organisations.

*Where�there�is�reference�to�the�Mental�Capacity�Act,�in�Scotland,�the�Adults with Incapacity Act�would�apply.


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AbbreviationsABCD2 Age,�Blood�pressure,�Clinical�features,�

Duration,�Diabetes

ADL Activities�of�Daily�Living

ASD Atrial�Septal�Defect

FAST Face,�Arm,�Speech,�Time

FES Functional�Electrical�Stimulation

IMCA� Independent�Mental�Capacity�Advocate

MDT Multidisciplinary�Team

NIHSS National�Institutes�of�HealthStroke�Scale

�

NSS National�Stroke�Strategy

PALS Patient�Advice�and�Liaison�Services

PFO Patent�Foramen�Ovale

PPI Patient�and�Public�Involvement

QOF Quality�and�Outcomes�Framework

SNSS Scandinavian�Neurological�Stroke�Scale


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UK Forum for Stroke Training membersThe�UK�Forum�for�Stroke�Training�had�members�who�represented�their�respective�groups,�as�well�as�patients�and�carers.�A�list�of�the�individuals�who�contributed�to�the�development�of�the�SSEF�can�be�found�in�section�Project�team�and�contributors.

Allied�Health�Professions�FederationAmbulance�ServiceBritish�Association�of�Stroke�Physicians�(BASP)British�Society�of�Neuroradiologists�(BSNR)/

Royal�College�of�Radiologists�(RCR)Chest,�Heart�and�Stroke�ScotlandDepartment�of�Health�Education�for�HealthNational�Institute�for�Health�and�Clinical�

Excellence�(NICE)National�Library�for�HealthNational�Stroke�Nursing�ForumNHS�DirectNHS�Stroke�Improvement�ProgrammePrimary�Care�Neurology�SocietyPsychologists�Researching�in�Stroke/British�

Psychological�Society�(PSYRIS/BPS)Public�HealthSafe�Implementation�of�Thrombolysis�in�

Stroke�–�Monitoring�Study�(SITS-MOST)Scottish�Stroke�NetworkSkills�for�Health/Skills�for�Care�(SFH/SFC)Social�ServicesSociety�and�College�of�RadiographersSociety�for�Vascular�Technology�(SVT)Strategic�Health�Authorities�(SHAs)/DeaneriesStroke�AssociationStroke�Research�Network�(SRN)Stroke�Strategy�Implementation�Project,�

Northern�IrelandRDInfoRoyal�College�A&E�ConsultantsRoyal�College�of�General�Practitioners�(RCGP)Royal�College�of�Nursing�(RCN)Royal�College�of�Speech�and�Language�

Therapists�(RCSLT)Royal�Pharmaceutical�Society�(RPS)Workforce�Review�Team


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›Developingastroke-skilledworkforce

›HowtousetheStroke-SpecificEducationFramework

›ElementsofcareontheStrokePathway


The Stroke-Specific Education FrameworkAttheStrokeForumin2007,itwasrecognisedthatnoframeworkexiststoguidetrainingforpeopleinvolvedinstrokecareandservices.EstablishingtheUKForumforStrokeTrainingandaStroke-SpecificEducationFramework(SSEF)willgoalongwaytowardsimprovingstrokeservicesnationwide.

ItisnottheForum’sintentiontodictatetocolleaguesinvolvedinstrokecareandserviceshowstaffshouldbetrainedanditunderstandsthattherearemanylocallyprovidedtrainingprogrammesthatarevaluable.However,ifweasagroupofpractitionerswishtodemonstratethequalityofservicethatweprovide,ourtrainingmustbeconsistentandmeasurable.

WecandothisthroughtheSSEF.

Wecanalsoofferallourcolleaguesinvolvedinstrokecareacknowledgementfortheworktheydoandmeaningfulcareerprogression.


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›Developing a stroke-skilled workforce



Developing a stroke-skilled workforce

TheStroke-SpecificEducationFramework(SSEF)isbasedaroundtheStrokePathwayandrelatestothe16elementsofcare.TheSSEFplaysjustonepartinthedevelopmentofastroke-skilledworkforce.Throughacademicstudy,anindividualcandemonstratethattheyhavetherequisiteknowledge,understanding,skillsandabilitieslistedintheSSEF.Intheworkplace,tobetrulyconsideredasstroke-skilled,theyneedtobeabletocombinethetheorytheyhavelearntwiththeirclinicalpractice.

ThismarriageoftheoryandpracticeshouldprovideprogressivelearningasevidencedbyContinuingProfessionalDevelopment(CPD).Fundamentaltostroke-specificskillsandwork-basedlearningaremoregenericskillsandcompetences;forexample,clinicalskills,ethics,communicationandteam-working.

Individualsshouldalsobeawareofcurrentguidelinesandrecommendations–andkeepuptodatewithadvancesinpractice.Therelationshipbetweengenericandstroke-specificcompetences,aswellaswork-basedlearning,canbeseeninthefollowingdiagram.


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Developing a stroke-skilled workforce

ThecontributionoftheStroke-SpecificEducationFramework:

WORK-BASED LEARNING

Continuing professional development »

STROKE-S

PECIFIC KNOWLEDGE AND SKILLS

GENER

IC C

OMPETEN

CES

STRO

KE-S

PE

CIFIC EDUCATION FRAM

EWO

RK» « THEORY » « PRACTIC

E » «

STROKE-SKILLED WORKFORCE DELIVERING

EVIDENCE-BASED CARE

• FI

RST

CONT

ACT • TREATMENT AND REHABILITATIO

N •

PREVEN

TIO

N • LONG-TERM SUPPORT A

ND RE

VIE

W


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Developing a stroke-skilled workforceGeneric competencesGenericcompetencesarenotstroke-specificbutareexpectedofsomeoneworkinginhealthorsocialcare(orthevoluntarysector)whoprovidesaserviceforothers.Thesecompetencesrelatetobehaviourandskillsthatarenotnecessarilyformallytaught.Genericskillsthatanindividualmayhavecouldincludeleadership,communicationandadvocacy,ortheabilitytotrain,researchormanage.Weshouldalsobeawareofthegenericskillsrequiredforworkingeffectivelyindependently–oraspartofateam.

Stroke-specific competences TheSSEFisguidedbythe16elementsofcareintheStrokePathwayandspecifiesthestroke-specificknowledgeandskillsthatanindividualshouldhaveiftheyareworkingwiththoseaffectedbystroke.Toco-ordinatestrokeservicesandsupport,organisationsandstaffshouldworkinpartnershipandberiskaware.


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Work-based learningTheSSEFwilldefinetheknowledgeandskillsthatshouldbeofferedtoindividualsthroughtraining,buttheseneedtobetranslatedintopracticeifworkforcedevelopmentistobeeffective.Thedegreeofindependenceexpectedfromindividualsforaparticulartask(whetheraphysicaltaskoradecision-makingprocess)willvaryaccordingtotheleveloflearning,professionalgroupandlocalclinicalenvironment.

Inmanylearningsituationstheindividualwill:

zz observeataskorlearnaboutataskperformedbysomeoneelse;

zz performthetaskwithhelp;

zz performthetaskthemselvesundersupervision;

zz performthetaskwithoutsupervision(includingthemanagementofcomplicationsandvariations);or

zz gainexperiencesuchthattheyareabletodemonstrateandsuperviseanotherlearner.

Toreinforcetheirlearning,individualsshouldreflectonhowtheirpracticerelatestotheknowledgetheyhaverecentlyacquired.Ideally,thisinvolvesdiscussionofwork-basedpracticeopportunitieswithaclinicalsupervisorandkeepingawrittenrecordofthesedevelopmentalexperiences,whichwillvaryaccordingtothecomplexityofthetask.

Aspartofthelearningexperience,allindividualsshouldbeallowedtotaketimetoreflectandconsiderhowtheirpracticerelatestotheirfactualknowledgeandbeabletoaskfortheadviceofasupervisorwhoisawareof


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thelearningoutcomesoftherelatedtraining.Trainingopportunitiesthatincludethiselementofwork-basedconsolidationoflearningaremuchmorelikelytobeviewedascompliantwiththeSSEF.

Continuing Professional DevelopmentCPDiscrucialformaintainingworkforceskillsanddevelopingnewknowledgeandnewevidence,andforserviceredesignandprogression.Health,social,voluntaryandindependentcareproviderswhousetheSSEFshouldbeawareofcurrentguidelinesforstroke–aswellaslocalpathways,services,andsupportforstrokeandTransientIschaemicAttack(TIA).Professionalsshouldalsomaintainandupdatetheirknowledgeofguidelinesandbeawareofnewdevelopmentswithinthelocalpathway.


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›How to use the Stroke-Specific Education Framework


How to use the Stroke-Specific Education Framework

TheStroke-SpecificEducationFramework(SSEF)ispresentedin16elementsoftheStrokePathway,eachwiththreesections.

Withineachelement,thethreeseparatesectionsrelateto:

zz theessentialrequirements;

zz knowledgeandunderstandingof;and

zz skillsandabilityto.

Withineachelementofcarethereareoftenexamplesgivenforpotentialinputsorproblems.Whereverexamplesaregiven,thereadermustrealisethatipsofacto,theexamplesdonotpurporttobeanexhaustivelist.


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Essential requirements (first section) ThisisalistoftheserviceandinputsthatarerelevanttothelevelofcareforeachelementwithintheStrokePathway.

RequirementsalongtheStrokePathwayinclude:Assessment;Preliminarydiagnosis/decision;Investigation;Finaldiagnosis/decision;Treatment/Management;Referraltootheragenciesandservices;andCommunication.

Knowledge and understanding of(second section)

Thisisalistofthestroke-specificknowledgeandunderstandingthatsomeoneworkinginstrokeshouldpossess.Thelevelofunderstandingorknowledgewillbedependentonthegroupthatisbeingtargeted.WithintheSSEF,inthecolumnheaded‘Knowledgeandunderstandingof’,thelevelrequiredcouldbeprefixedbyoneofthefollowing(definitionsfromSkillsforHealth):

zz Basic –thecriteriademandonlyaverylimitedandgeneralisedunderstandingthatsomethingexistsbutanindividualwouldnotneedtoknowanydetails.


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zz Factual–thecriteriacallforaknowledgethatisdetailedonafactuallevel,butdoesnotinvolveanymorethanasuperficialunderstandingofanyprinciplesortheories.

zz Working–thecriteriacallfortheapplicationoffactualknowledgeofwidelyunderstoodtechnicalprinciplesandimplicationswithinthefieldofpractice.

zz In-depth–thecriteriademandabroadanddetailedunderstandingofthetheoreticalunderpinningofanareaofpractice,includingconflictingtheoriesandconstructs.

zz Critical–thecriteriacallfortheabilitytoevaluateanddeviseapproachestosituationsthatdependonthecriticalapplicationoftheoriesandconceptualconstructswithintheareaofpractice.

Itwillbetheremitofthepeoplewhoprovidethecoursetodecideonwhichlevelisappropriateforeachindividualtrainee,butateachlevelthetraineeshouldunderstandwhytheyaredoingwhattheyaredoing.


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Skills and ability to (third section)Thissectionisabouttranslatingknowledgeandunderstandingintopractice,inparticularwithregardtotheavailabilityoftherelevantservicesthatareavailablelocallyorthatcanbeaccessedoutsidethelocalarea.Thefollowinglistsummarisesthefocusoftheskills,where“it”couldbeanyinvestigation,interventionorreferral:

zz Whatitisthatneedstobedone

zz Whenitneedsdoing

zz Whereitisdone

zz Howitshouldbedone

zz Whoitisdoneto.

Additionalskillsincludecommunicationandparticipationinresearchandaudit.

Itisimportantthatstaffparticipateinresearchandaudit.Thiswillhelpthemdevelopadditionalskillsandgivethemanappreciationofhowpatientcarecanbeinformedbythefindingsfromresearchandauditstudies(i.e.evidence-based).

Thestrokepopulationhasveryspecificandseverecommunicationdifficulties.Whenevercommunicationismentionedwithinthisframeworkitneedstobeatalevelandusingamethodandformatappropriatefortheindividualandthesituation.Pre-existingcommunicationdifficultiesshouldalsobetakenintoconsiderationwhencommunicatingwithstrokepatients.Anyinformationprovidedmustbeinaformatthatisrelevantandaccessibleforthepersonandtheirfamily.Considerationsinclude:cultural,language,educationallevels,aphasia-friendly,pre-existingdeficits.Writteninformationmustalsobemadeavailable.


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›Elements of care on the Stroke Pathway

Elements of care on the Stroke Pathway

1. Awarenessraising:strokeasamedicalemergency2. Managingrisk:primaryandsecondaryprevention3. Information,adviceandsupporttothoseaffectedbystroke4. Userinvolvementincareandserviceplanning5. Assessment(TIA):assessmentandmanagementattimeofevent6. Treatment(TIA):assessmentandmanagementatfollow-up7. Urgentresponse:pre-hospitalassessmentandmanagement8. Assessment(stroke):emergencyassessmentandmanagement9. Treatment(stroke):earlyassessmentandmanagement10. High-qualityspecialistrehabilitation11. End-of-lifecare12. Seamlesstransferofcare13. Long-termcareandsupport14. Review15. Participationincommunitylife16. Returntowork


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Knowledge SkillsRequirements

Project team and contributers

1. Awareness raising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork

1 Awareness raising: stroke as a medical emergency

Essential requirementsThisisalistoftheserviceandinputsthatarerelevantforthiselementwithintheStrokePathway.

zz Assessmentzz Preliminarydiagnosis/decisionzz Investigationzz Treatment/managementzz Communication


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Knowledge and understanding of…zz signsandsymptomsofstrokezz featuresoflesscommon(atypical)presentationofstrokezz strokemimicsandlikelypresentationzz strokeandTIAasmedicalemergencieszz emergencyresponse,investigations,interventionsandtreatmentsforstrokeandTIAzz timeframeforemergencyinvestigations,interventionsandtreatmentsforstrokeandTIAzz anatomyandphysiologyofthecentralnervoussystemzz timeframeofphysiologicalandneurologicalchangesduringastrokezz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationsIn addition, take into account the knowledge and understanding relating to 7.Urgentresponse.


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Skills and ability to…zz initiateemergencyprotocol(StrokeImprovementProgramme)zz communicatecurrenteventandneedforemergencytreatmentzz knowwhentoapplyscreeningtestsforstroke(FAST)andhowtoactontheresultszz knowwhentoapplyvascularriskassessmenttoolsforTIA(ABCD2)andhowtoactontheresultszz identifyemergencyinterventionsandtreatmentsforstrokeandTIAavailablelocallyandknowhowtorefer

patientsefficientlyzz takeandinterpretthoroughhistory,takingthirdpartyinformationwherepossible,andassessmentalcapacityzz identifyandappropriatelytreatstrokemimics,e.g.hypoglycaemia,epilepticseizure

In addition, take into account the skills and ability required under 7.Urgentresponse.



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2 Managing risk: primary and secondary prevention


zz Assessmentzz Preliminarydiagnosis/decisionzz Investigationzz Treatment/managementzz Referraltootheragenciesandservices

1. Awarenessraising2. Managing risk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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Knowledge and understanding of…zz riskfactorsforstrokeandTIA(e.g.lifestyle,socioeconomic,cultural,vascular,familial,genetic,concurrent

medications,comorbidities)zz stroketypesandtheiraetiologieszz riskofstrokedependingontypeandaetiologyzz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationszz whoprovidesinterventionsforprimaryandsecondarypreventionofstrokezz pharmacologicalandnon-pharmacologicalinterventionsforprimaryandsecondarypreventionofstroke,and

sideeffectsoftreatment

zz methodsofchangingbehaviourIn addition, take into account the knowledge and understanding relating to 3.Information and 5.Assessment(TIA).



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Skills and ability to…zz takeandinterpretthoroughhistory,takingthirdpartyinformationwherepossible,andassessmentalcapacityzz determine,planandinitiateappropriateassessments/investigationsandinterventions/treatments;provide

information,relevanttoindividualneedsandaspirations(personaliseinformation)zz elicitneedsandaspirationsofthoseatriskofstrokeandthoseaffectedbystrokezz identifyriskfactorsandapplyvascularriskassessmenttoolszz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,

interventions/treatmentsandtheirtimeframes;rationalefortreatment;andpossiblesideeffectsoftreatment;andprovidetimelyinformationadviceandsupport

zz assessservices(health,social,voluntaryandindependent)availablelocallyforthoseaffectedbystroke:identifyfullrangeavailable;establishrelevance;communicateandliaisewithservices;signpostservice

zz assessmotivationandtakestepstoaugmentmanagementzz monitorprogressandagreeorchangeamaintenanceormanagementplanzz assessandfacilitateconcordance

In addition, take into account the skills and abilities required under 3.Information and 4.Userinvolvement.



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3 Information, advice and support to those affected by stroke


zz Assessment�z Personandfamily-ledassessment�z Information

zz Treatment/management�z Personandfamily-ledmanagement(medicalandnon-medical)�� Identifyingpriorities�� Understandinghowtochangebehaviour

�z Secondaryprevention�� Health�� Lifestyle�� Concordance(e.g.ensurethatthepatienttakesmedication,attendstherapysessions)

�z Socialcare�z Respite�z Equipment�z Adaptations

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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zz Communication�z Withpatient/family/team�z Adviceonstroke,lifestyle,workanddrivingadvice

zz Referralandre-referral�z Otheragenciesandservices(smoothandseamlesspathwayofcareacrossandbetween)


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Knowledge and understanding of…zz stroketypesandtheiraetiologieszz riskfactorsforfurthervascularevents(e.g.typeandaetiologyofcurrentevent,lifestyle,socioeconomic,

cultural,vascular,familial,genetic,concurrentmedications,comorbidities)zz pharmacologicalandnon-pharmacologicalinterventionsforprimaryandsecondarypreventionofstroke,and

sideeffectsoftreatmentzz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationszz whoprovidesinterventionsforprimaryandsecondarypreventionofstrokezz fullrangeofservices(health,social,community,voluntaryandindependent)availablelocallyforthoseaffected

bystrokezz howtoassessandovercomebarrierstoproblems:psychologicalandemotional;socialandrelationship;

cognitiveandcommunication;physicalandfunctional;visualandsensoryimpairmentsandpain;medicalzz theimpactofstrokeontheindividual,carerandfamilyzz theimplicationsofstrokeforlifestyle,driving,workandfamilyzz methodsofchangingbehaviour

In addition, take into account the knowledge and understanding relating to 2.Managingrisk and 10.Specialistrehabilitation



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Skills and ability to…zz takeandinterpretthoroughhistory,takingthirdpartyinformationwherepossible,andassessmentalcapacityzz elicitneedsandaspirationsofthoseaffectedbystrokezz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,

interventions/treatmentsandtheirtimeframes;rationalefortreatmentandpossiblesideeffectsoftreatment;andprovidetimelyinformation,adviceandsupport

zz identifyfullrangeofservices(health,social,community,voluntaryandindependent)availablelocallyforthoseaffectedbystroke

zz assessrelevanceandsuitabilityofavailableservicesforthoseaffectedbystroke;communicateandliaisewithservices;shareinformation;workacrossagencies;signpostservicesforthoseaffectedbystroke

zz implementinformationsharingmethodsandreflectoneffectivenessofinformationsharingzz assessmotivationandtakestepstoaugmentmanagementzz monitorprogressandagreeorchangeamaintenanceormanagementplaninconjunctionwiththoseaffected

bystroke,identifyingresourcestofacilitateparticipationandinclusion

In addition, take into account the skills and abilities required under 2.Managingrisk and 10.Specialistrehabilitation.



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4 User involvement in care and service planning


zz Engagementzz Accessibilityzz Advocacyzz Monitoring�z Consultation�z Evaluation�z Feedback

1. Awarenessraising2. Managingrisk3. Information4. User involvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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Knowledge and understanding of…zz theservicesrelevantforstrokepatientsandcarerszz howtoassessandovercomebarrierstoproblems:psychologicalandemotional;socialandrelationship;

cognitiveandcommunication;physicalandfunctional;visualandsensoryimpairmentsandpain;medicalzz methodstoempowerpatients;patientadvocacyzz methodsthatcanbeusedtoinvolvestrokepatientsandcarersinserviceplanningzz methodsthatcanbeusedtocapturestrokepatientandcarerviewszz methodsforusingviewstoinfluenceserviceszz factorsthatinfluencepeople’sabilitytobeinvolvedincareandserviceplanningzz methodsoffeedingbacktostrokepatientsandcarershowtheircontributionshaveinfluencedserviceszz howserviceplanninganddecisionmakingprocessesworkandhowtheycanbeinfluenced

In addition, take into account the knowledge and understanding relating to 10.Specialistrehabilitation.


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Skills and ability to…zz assessservices(health,social,voluntaryandindependent)availablelocallyforthoseaffectedbystroke:identify

thefullrangeavailable;establishrelevance;communicateandliaisewithservices;signpostservicezz createanopenandhonestenvironmentthatisnotintimidatingandoffersstrokepatientsandtheircarersthe

opportunitytofreelygivetheirviewszz interactwithpeoplewhohaveoneormoreofthefollowingproblems:communication;physical/functional;

psychological;social;medicalzz translatetheviewsofthoseaffectedbystrokeintoserviceplanning,development,deliveryandmonitoringzz identifyhard-to-reachgroupsandensurethattheirviewsareincludedzz overcomethefactorsthatpreventthoseaffectedbystrokefrombeinginvolvedincareandserviceplanningzz identifylocalopportunitiesandappropriateformatsforformalandinformalfeedback(e.g.PALS,PPI)zz handlecomplaintstothesatisfactionofallparties



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5 Assessment (TIA): assessment and managementat time of event


zz Assessmentzz Preliminarydiagnosis/decision�z Identificationofsuspectedstroke�z Makeaclinicaldiagnosis

zz Investigation�z Biochemistryandhaematology�z Imaging�z Cardiovascularassessment

zz Treatment/management�z Initiatetreatment�z Secondaryprevention�z Vascularsurgery

zz Referraltootheragenciesandserviceszz Communication�z Lifestyle,workanddrivingadvice

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment (TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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Knowledge and understanding of…zz anatomyandphysiologyofthecentralnervoussystemzz riskfactorsforstrokeandTIA(e.g.lifestyle,socioeconomic,cultural,vascular,familial,genetic,concurrent

medications,comorbidities)zz thesignsandsymptomsofTIAzz howtodistinguishbetweenstrokeandTIAzz thefutureriskofstrokeandTIA(e.g.ABCD2andotherriskscoringmethods)zz thefeaturesofatypicalpresentationofTIA/strokeandmimicsandhowtoactwhentheyareidentifiedzz investigations,interventionsandtreatmentsforTIA(e.g.imaging,vascular,medical,cardiac,surgical)zz implicationsoftheMentalCapacityActandhowitappliestoTIAzz advocatesforstrokeandTIApatientswhenthereisalegaldutytoinstructanIMCA,takingaccountof

religiousandculturalaspirationszz thetimeframeforemergencyandfollow-oninvestigations,interventionsandtreatmentsforTIAzz howtoinitiateemergencyandongoingtreatmentforTIAandvascularpreventionzz theindications,contraindicationsandlimitationsforimaging,investigationsandinterventionszz localprotocolsforimagingandreportingzz anycomplicationsofsurgicalprocedures(e.g.stenting,carotidendarterectomy,closureofatrialseptaldefect

(ASD)andpatentforamenovale(PFO))zz theresultsofinvestigationszz theimplicationsofTIAforlifestyle,driving,workandfamily



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Knowledge and understanding of… (continued)zz managementoptionsforTIA/strokeandmimics,andotherconditions

In addition, take into account the knowledge and understanding relating to 2.Managingrisk.


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Skills and ability to…zz takeandinterpretthoroughhistory,recordthirdpartyinformationwherepossible,andassessmentalcapacityzz determine,planandinitiateappropriateassessments/investigationsandinterventions/treatments;provide

information,relevanttoindividualneedsandaspirations(personaliseinformation)zz identifyriskfactorsandapplyvascularriskassessmenttoolsforTIA(ABCD2)andscreeningtestsforstroke

(FAST)

zz identifystroke,highriskTIA,lowerriskTIA,atypicalstrokeandstrokemimicszz establishthecauseofTIAzz recognisepatientswhohavehadastrokeratherthanaTIAandtoreferonforappropriateinvestigationand

managementzz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,

interventions/treatmentsandtheirtimeframes;rationalefortreatment;andpossiblesideeffectsoftreatment;andprovidetimelyinformation,adviceandsupport

zz identifyemergencyinterventionsandtreatmentsforTIAavailablelocallyandknowhowtoreferpatientsefficiently

zz identifytheservice(s)towhichtheindividualshouldbereferredandtoliaiseeffectivelywiththoseserviceszz performaphysiologicalassessmentandassessvitalsignszz decideonarelevantinvestigationanditslevelofurgencyzz applyradiologicalknowledgeforrecognisedinvestigationszz applytechnicalknowledgeforrecognisedinvestigationsandinterventionszz applysurgicalknowledgeforrecognisedvascularinterventions



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Skills and ability to…(continued)zz recogniseandmanagepostoperativecomplicationsafterstenting,endarterectomy,PFOandASDclosurezz obtainandinterprettheresultsofinvestigations:thisincludesformulatinganimmediateandongoing

managementplan,andinitiatingtreatmentswithintherelevanttimelineszz confirmandcommunicatediagnosis,lifestyleadviceandmethodsofsecondarypreventiontopatientsand

carerszz communicateanddiscusswiththepatient,carer,andhealthandsocialcareprofessionalsadiagnosis,results

ofinvestigationsandsubsequentneedsandaspirationsandamanagementplan,aswellastheactionstobetakenifafurthervasculareventoccurs

zz adviseonlifestyle,driving,workandfamilyzz identifylocalmanagementandreferralroutesforTIA/strokeandmimics,andotherconditions

In addition, take into account the skills and abilities required under 8.Assessment(stroke); 9.Treatment(stroke); 10.Specialistrehabilitation; 12.Seamlesstransferofcare; 13.Long-termcare; 14.Review and 15.Participationincommunity.


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1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment (TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork

6 Treatment (TIA): assessment and managementat follow-up


zz Assessmentzz Finaldiagnosis/decisionzz Furtherinvestigationzz Treatment/management�z Follow-upatonemonth�z Secondaryprevention:ongoing/regularreview

zz Referraltootheragenciesandservices�z TIAswithongoingproblems,TIAmimicsandstrokes

zz Communication�z TIA/minorstrokeadvice�z Lifestyleanddrivingadvice


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Knowledge and understanding of…zz thesignsandsymptomsofTIAzz atypicalpresentationofTIAandTIAmimicsandhowtoactwhentheyareidentifiedzz howtodistinguishbetweenstrokeandTIAzz riskfactorsforfurthervascularevents(e.g.typeandaetiologyofcurrentevent,lifestyle,socioeconomic,

cultural,vascular,familial,genetic,concurrentmedications,comorbidities)zz pharmacologicalandnon-pharmacologicalinterventions,andthelevelofurgencyforriskfactormanagementzz sideeffectsofpharmacologicalandnon-pharmacologicalinterventionsaswellasthepreventionand

managementofvasculareventszz latecomplicationsofsurgicalprocedures(e.g.stenting,carotidendarterectomy,closureofASDandPFO)and

theimplicationsoftheproceduresonlifestylezz implicationsofTIAforlifestyle,driving,workandfamilyzz potentialinterventionsforimmediateandongoingriskfactormanagementzz methodsofchangingbehaviourzz howQOFandcommunitytargetsforriskfactormanagementaffectpreventionstrategieszz concordance:howtoassess;howitisaffectedbyindividualpreference;howtomotivate;howtomanage

non-concordancezz likelypersistentdeficitsorotherongoingproblemszz whyTIA/strokereviewisimportant




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Skills and ability to…zz recogniserecurrentvasculareventszz performaholisticoverview,includingassessmentofpharmacologicalandnon-pharmacologicalinterventionszz performandinterpretbloodpressuremeasurementandECGzz assessandfacilitateconcordancezz assessmotivationandtakestepstoaugmentmanagementzz monitorprogressandagreeorchangeamaintenanceormanagementplanzz useresultsofhistoryandinvestigationstoconfirmadiagnosisandmakeanindividualmanagementplanfor

thepatient,takingintoaccountpersonalpreferenceszz identifyinterventionsandtreatmentsforstrokeandTIAavailablelocallyandknowhowtoreferpatientsefficientlyzz communicateanddiscusswiththepatient,carer,andhealthandsocialcareprofessionaladiagnosis,results

ofinvestigationsandsubsequentneedsandaspirationsandamanagementplan,aswellastheactionstobetakenifafurthervasculareventoccurs

zz identifywhoprovidesinterventionsforimmediateandongoingriskfactormanagementlocallyandreferzz identifywhereQOFandcommunitytargetsforriskfactormanagementmayaffectpreventionstrategiesand

takestepstoovercomethiszz recogniseindividualswithpersistentdeficitsorotherongoingproblemsandarrangerehabilitation,supportand

managementzz encouragepeopletocomeforreview

In addition, take into account the skills and abilities required under 13.Long-termcare and 14.Review.


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1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgent response8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork

7 Urgent response: pre-hospital assessment and management


zz Assessment�z Recognisesuspectedstroke

zz Preliminarydiagnosis/decision�z Makepreliminarydiagnosis�z Clinicalassessment�z Confirmpreliminarydiagnosis

zz Treatment/management�z Initiatemonitoring�z Preventcomplications�z Taketocorrectplace

zz Communication


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Knowledge and understanding of…zz signsandsymptomsofstrokezz featuresoflesscommon(atypical)presentationofstrokezz strokemimicsandlikelypresentationzz strokeandTIAasmedicalemergencieszz emergencyresponse,investigations,interventionsandtreatmentsforstrokeandTIAzz thetimeframeforemergencyinvestigations,interventionsandtreatmentsforstrokeandTIAzz anatomyandphysiologyofthecentralnervoussystemzz thephysiologicalandneurologicaleffectsofstrokeandtheirtimeframeduringandafterastrokezz monitoringandactinguponphysiologicalandneurologicalchangesduringandafterastrokezz howstrokecanaffectcommunicationzz implicationsoftheMentalCapacityActandhowitappliestostrokeandTIAzz advocatesforstrokeandTIApatientswhenthereisalegaldutytoinstructanIMCA,takingaccountof

religiousandculturalaspirationszz complicationsafterstroke(e.g.aspiration,airwayobstruction,hypoxia,hypotension,hypertension,

hyperglycaemia,bedsores),andpreventingandmanagingthem

In addition, take into account the knowledge and understanding relating to 1.Awarenessraising; 5.Assessment(TIA) and 8.Assessment(stroke).



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Skills and ability to…zz takeandinterpretthoroughhistory,recordthirdpartyinformationwherepossible,andassessmentalcapacityzz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,


zz identifysuspectedstroke,performscreeningtests(e.g.FAST)andactonresultszz performbasicneurologicalandphysiologicalassessment(vitalsigns)zz performABCDs(airways,breathing,circulation,disability),pulseoximetryandbloodglucoseassessmentand

toactonabnormalfindingszz identifyandusemethodsofmovingandhandlingthepatientthataresafe,dependingontheindividual

patientorstaffneedszz recognisestroke-relatedcommunicationproblemsandtoadaptmethodsofcommunicationzz identifyemergencyinvestigations,interventionsforstrokeandTIApatientsavailablelocally(StrokeNetworks)

andknowwheretotakethemzz identifyandappropriatelytreatstrokemimics,e.g.hypoglycaemia,epilepticseizure


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1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment (stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork

8 Assessment (stroke): emergency assessment and management


zz Assessmentzz Preliminarydiagnosis/decision�z Identificationofsuspectedstrokes�z Makeaclinicaldiagnosis

zz Investigation�z Biochemistryandhaematology�z Brainimaging�z Cardiovascularassessment

zz Treatment/management�z Initiatetreatment�z Preventanddetectdeteriorations�z Accesstorapidneurovascular/vascularsurgery�z Intensivecare�z Young/atypicalstroke�z Specialistassessmentofstrokewithunusualpresentationsand/orinyoungpeople�z Highlyspecialisedtreatments

zz Communication


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Knowledge and understanding of…zz thesignsandsymptomsofstrokezz theneurologicalandphysiologicaleffectsofstrokeandthetimeframeofchangesduringandafterastrokezz howtomonitor,andactupon,neurologicalandphysiologicalchangesduringandafterastrokezz implicationsoftheMentalCapacityActandhowitappliestostrokeandTIAzz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationszz featuresofatypicalpresentationofstrokeandstrokemimicszz stroketypesandtheiraetiologieszz differentmodalitiestofacilitatediagnosisandtreatmentofstroke(e.g.telemedicine)zz emergencyinvestigations(e.g.imagingofbrain,heartandcerebralarteries,bloodtests)andinterventionsfor

stroke(e.g.intravenousandintra-arterialthrombolysis,vascularsurgery,stenting,hemicraniotomy,evacuationofhaematoma)andthetimeframewithinwhichtheyshouldbegiven

zz theindicationsandcontraindicationsforinvestigations,interventionsandtreatmentsforstrokezz anycomplicationsofinvestigations,interventionsandtreatmentsforstrokeandhowtopreventand

managethem

In addition, take into account the knowledge and understanding relating to 5.Assessment(TIA); 6.Treatment; 7.Urgentresponse and 9.Treatment(stroke).


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information,relevanttoindividualneedsandaspirations(personaliseinformation)zz performneurologicalandphysiologicalassessmentandassessvitalsignszz performastandardisedneurologicalassessmentusingarecognisedstrokescale(e.g.NIHSS,SNSS)zz interprettheresultsofinvestigations(e.g.imaging,vascular,bloodtests)andtheactionstobetakenasaresultzz diagnosestrokeusingclinicalinformationandinvestigations:distinguishbetweenastrokeandaTIA;identify

atypicalstrokesandstrokemimics;formulateandimplementamanagementplanaccordinglyzz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,


zz identifytheneedformorespecialistordifferingtreatmentswhennecessaryandbeabletorefertothoseservices

zz monitorprogress,identifycomplicationsordeteriorationsanddelivertreatmentsforcomplicationsordeteriorations

zz identifythelevelofurgencyforanyrelevantmedical,surgicalandradiologicalinvestigations,interventionsandtreatments

zz obtainandinterprettheresultsofinvestigationsandformulateanimmediateandongoingmanagementplan;initiatetreatmentswithintherelevanttimescales

In addition, take into account the skills and abilities required under 5.Assessment(TIA); 6.Treatment(TIA) and 7.Urgentresponse.


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9 Treatment (stroke): early assessment and management


zz Assessmentzz Finaldiagnosis/decisionzz Investigationzz Treatment/management�z Preventingcomplications�z Providerehabilitationwithappropriate�� frequency�� intensity�� duration

�z Dischargeplanning�z Communicatingeffectivelywithpatient/family/team

zz Referraltootheragenciesandservices�z Individualswithotherspecialistsupportandmanagementneeds

In addition, take into account the service required under 12.Seamlesstransferofcare.

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment (stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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Knowledge and understanding of…zz signsandsymptomsofstrokezz neurologicalandphysiologicaleffectsofstroke,monitoring,andthetimeframeofchanges,duringandaftera

strokezz theneedforearlymobilisationandpositioningzz assessingswallowingandmanagingofdysphagiazz alternativemethodsoffeeding,hydrationanddrugadministrationforpatientswithdysphagiazz theinteractionsbetweenenteralfeeds,fluidsanddrugtreatmentzz theeffectsofstoppingongoingdrugtreatmentbecauseofswallowingproblemszz symptomsandeffectsofmalnourishmentzz theimportanceandmethodsoforalhygienezz theimportanceofavoidingcatheters,aswellasmanagingretentionandpromotingcontinencezz assessingandmanagingproblems:psychologicalandemotional;socialandrelationship;cognitiveand

communication;physicalandfunctional;sensoryimpairmentandpain;medicalzz cognitiveeffectsofthestrokeandtheirimpactonthepatient’sabilitytoconsenttotreatmentzz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationszz theimpactofthestrokeonfamily,friendsandcarerszz assessmentandmanagementoptionsforneurological,physiological,functionalandpsychologicalproblems

afterstroke



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Knowledge and understanding of…(continued)zz complicationsafterstrokeandhowtopreventandmanagethemzz whentoreferforotherspecialistcare(e.g.intensivecareunit,hemicraniotomy,haematomaevacuation,

interventionalradiology,vascularsurgery)zz anycomplicationsofinvestigations,interventionsandtreatmentsforstrokeandhowtopreventandmanage

themzz theroles,levelandnumberofhealthandsocialserviceprofessionalswhoshouldcontributetothecareand

supportofindividualswithstrokeandthoseaffectedbystrokezz howtomanagestrokesthatoccurasacomplicationofanotherprimarypathology

In addition, take into account the knowledge and understanding relating to 7.Urgentresponse;8.Assessment(stroke) and 10.Specialistrehabilitation


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information,relevanttoindividualneedsandaspirations(personaliseinformation)zz performneurologicalandphysiologicalassessmentandassessvitalsignszz performastandardisedneurologicalassessmentusingarecognisedstrokescale(e.g.NIHSS,SNSS)zz identifytheneedandlevelofurgencyfortherelevantmedical,surgicalandradiologicalinvestigations,

interventionsandtreatments;obtainandinterprettheresultsofinvestigations:formulateanimmediateandongoingmanagementplan;initiatetreatmentswithintherelevanttimescales

zz diagnosestrokeusingclinicalinformationandinvestigations:distinguishbetweenastrokeandaTIA;identifyatypicalstrokesandstrokemimics;formulateandimplementamanagementplanaccordingly

zz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,interventions/treatmentsandtheirtimeframes;rationalefortreatment;andpossiblesideeffectsoftreatment;andprovidetimelyinformation,adviceandsupport

zz identifytheneedformorespecialistordifferingtreatmentswhennecessaryandbeabletorefertothoseserviceszz monitorprogress,identifyneurologicalandnon-neurologicalcomplicationsordeteriorationandtodeliver

treatmentszz obtainandinterprettheresultsofinvestigationsandformulateamanagementplanaccordingly



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Skills and ability to… (continued)zz identifyandusetherapeuticmethodsofmovingandhandlingthepatientthataresafe,dependingonthe

individualpatientorstaffneedsandaspirationszz assessandmanage:oralproblemsincludingdysphagia,nutritionandhydration;cognition;psychologicaland

emotionalproblems;continence;pressureareas;mobilityproblemsetcincollaborationwithmembersofthemultidisciplinaryteam

zz deliverrelevantmethodsofnutrition,hydrationandmedicationinpatientswithdysphagiazz assessanddiscussrealisticgoalswiththoseaffectedbystroke,plandischargeandlinktofollow-upservices

forpatientsandcarerszz recogniseimpendingdeathandinitiatepalliativecarewherenecessary

In addition, take into account the skills and abilities required under 5.Assessment(TIA); 6.Treatment(TIA); 10.Specialistrehabilitation; 11.End-of-lifecare; 12.Seamlesstransferofcare; 13.Long-termcare; 14.Review and 15.Participationincommunity.


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10 High-quality specialist rehabilitation


zz Assessment�z EffectiveMDTassessment�z Goalsetting

zz Preliminarydiagnosis/decisionzz Investigationzz Treatment/management�z Personandfamily-ledmanagement(medicalandrehabilitation)�z Initiatingtreatment�� Medical�� Non-medical

�z Utilisingarangeofmethods�z Talkingwithpeople�z Identifyingpriorities�z Understandinghowtochangebehaviour�z Immediateaccesstostrokespecialistrehabilitation

zz Referraltootheragenciesandserviceszz Communication

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialist rehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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Knowledge and understanding of…zz theimpactofstrokeontheindividual,carerandfamilyzz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationszz theimplicationsofstrokeforlifestyle,driving,work,familyandacceptanceinthecommunityzz MDTassessment:theprinciplesofstrokerehabilitationandrehabilitationreferral;therapytechniquesandtheir

applicationzz arangeofneurologicaltreatmentapproachesandtheirapplicationszz psychological and emotionalproblemsafterstroke(e.g.depression,emotionalism,anxiety,selfesteem,

confidence,well-being,challengingbehaviour)zz social and relationshipproblemsafterstroke(e.g.sex,lifestyle,work,housing,driving,transport,leisure,

financial/income,work/employment,children,family,supportnetwork,carers,respite,pets)zz cognitive and communicationproblemsafterstroke(e.g.spatialawareness(neglect/inattention);visualfield

deficits;hemianopia;memory;attention;praxis;executivefunction;aphasia,dysarthria,articulatorydyspraxia)zz physiological,physical and functionalproblemsafterstroke(e.g.restandsleep;respiratory,mobility;balance;

senses;incontinence;bladderandbowelmanagement;swallowing;feeding,nutritionandhydration;skinintegrity;sexual;motorcontrol;ADL)

zz neurological, visual and sensory impairments and painproblems(e.g.shoulderpain,centralpost-strokepain,spasticity,seizures)

zz medicalproblems(e.g.medication,comorbidities,complications)


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Knowledge and understanding of… (continued)zz theprocessoftransfertothecommunity(e.g.dischargeplanning,long-termmanagement,further

rehabilitation,socialfunction)zz thecausesof,andhowtoassess,manageandtreat,problemsafterstroke:psychologicalandemotional;social

andrelationship;cognitiveandcommunication;physiological,physicalandfunctional;neurological,visualandsensoryimpairmentsandpain;medical

zz theimpactofproblemsafterstrokeonday-to-dayandoutdoorfunctioning:psychologicalandemotional;socialandrelationship;cognitiveandcommunication;physiological,physicalandfunctional;neurological,visualandsensoryimpairmentsandpain;medical

zz methodsthatwillsupportthoseaffectedbystrokewiththeirrecoveryandhelpthemtocopewithproblemsafterstroke:psychologicalandemotional;socialandrelationship;cognitiveandcommunication;physiological,physicalandfunctional;neurological,visualandsensoryimpairmentsandpain;medical

zz riskfactorsforfurthervascularevents(e.g.typeandaetiologyofcurrentevent,lifestyle,socioeconomic,cultural,vascular,familial,genetic,concurrentmedications,comorbidities)

zz pharmacologicalandnon-pharmacologicalinterventionsforsecondarypreventionthatwillalsohelprecoveryafterstroke,andtheirsideeffects

zz anysupportservices,organisationsandresourcesavailable(e.g.health,social,voluntary,independentsector;packagesofcare,financeandpersonalbudgets,self-management,respitecare,equipment,adaptations,rehabilitation,psychological,educational,employment,housing,transport)

zz methodstofacilitatecommunicationwiththoseaffectedbystrokezz therapeuticmovingandhandling


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Knowledge and understanding of… (continued)zz methodsofchangingbehaviourzz theuseofassessmentsandmeasureszz theprinciplesofgoalsettingzz assistivetechnologyandothertherapyinterventions(e.g.functionalelectricalstimulation,orthotics)zz equipmentandadaptationszz concordance:howtoassess;howitisaffectedbyindividualpreference;howtomotivate;howtomanage

non-concordance

In addition, take into account the knowledge and understanding relating to 2.Managingrisk3; Information; 4.Userinvolvement; 5.Assessment(TIA); 6.Treatment(TIA); 9.Treatment(stroke); 12.Seamlesstransferofcare and 13.Long-termcare.


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Skills and ability to…zz takeandinterpretthoroughhistory,includinginformationfromcarers,relativesandotheragencieswhere

possible,andassessmentalcapacityzz determine,planandinitiatetimelyandappropriateassessments/investigationsandinterventions/treatments;

provideinformation,relevanttoindividualneedsandaspirations(personaliseinformation)zz providearangeofneurologicalinterventionprocessesandtobeabletoclinicallyreasontheselectionand

administrationofanapproachzz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,


zz assess,discussandreviewwiththoseaffectedbystroke,includingclient-centredgoal-settingandoutcomeszz identifyrehabilitationandsupportservicesinhospitalandafterdischarge:informtheindividualaboutservices

andhowtoaccessthem;checkavailabilityandagreereferralzz identifyneedandwhentoreferformorespecialistordifferingtreatmentswherenecessary:alsoagreereferral

(e.g.assistivetechnology,majoradaptationstothehome,disabilityemploymentadviser)zz provideadviceandsupportondrivingandrefertospecialistcentresasrequiredzz identifylocalservicesandresources(e.g.health,social,voluntary,independentsector;equipmentand

adaptations,rehabilitation,psychological,educational,employment,housing,transport)toovercomebarriers,facilitateparticipationandinclusion:alsoidentifywaitingtimesandimplicationsforthoseaffectedbystroke

zz monitorprogressandagreeorchangeamaintenanceormanagementplanzz identifyresourcestohelpwithparticipationandinclusion


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Skills and ability to…(continued)zz assessmotivationandtakestepstoaugmentmanagementzz assessandhelpwithconcordancezz identifyandusetherapeuticmethodsofmovingandhandlingthepatientthataresafe,dependingonthe

individualpatientorstaffneedsandaspirations,andthatwillhelpwiththeoptimumreturnoffunctionalabilities

zz assist,encourageandfacilitatepost-strokephysical,socialandculturalreintegrationzz recognisethesigns,symptomsandimpactofpsychological and emotionalproblemsafterstroke

(e.g.depression,emotionalism,anxiety,selfesteem,confidence,well-being,challengingbehaviour)andtohelppatientsandtheirfamiliestocopeandmanage;buildself-esteemandconfidence,encouragerecoveryandmaximisepotential

zz recognisethesigns,symptomsandimpactofsocial and relationshipproblemsafterstroke(e.g.lifestyle,work,housing,driving,transport,leisure,financial/income,work/employment,children,family,supportnetwork,carers,relating,respite,pets)andtohelppatientsandtheirfamiliestocopeandmanage;encouragerecoveryandmaximisepotential

zz recognisethesigns,symptomsandimpactofcognitive and communicationproblemsafterstroke(e.g.spatialawareness(neglect/inattention);hemianopia;visualfielddeficits;memory;attention;praxis;executivefunction;aphasia,dysarthria,articulatorydyspraxia)andtohelppatientsandtheirfamiliestocopeandmanage;encouragerecoveryandmaximisepotential


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Skills and ability to…(continued)zz recognisethesigns,symptomsandimpactofphysiological, physical and functionalproblemsafterstroke

(e.g.restandsleep;respiratory,mobility;balance;senses;incontinence:bladderandbowelmanagement;swallowing;feeding,nutritionandhydration;skinintegrity;sexual;motorcontrol;ADL)andtohelppatientsandtheirfamiliestocopeandmanage;encouragerecoveryandmaximisepotential

zz recognisethesigns,symptomsandimpactofneurological, visual and sensory impairments and painproblems(e.g.shoulderpain;centralpost-strokepain;spasticity,seizures)andtohelppatientsandtheirfamiliestocopeandmanage;encouragerecoveryandmaximisepotential

zz recognisethesigns,symptomsandimpactofmedicalproblems(e.g.medication,comorbidities,complications)andtohelppatientsandtheirfamiliestocopeandmanage;encouragerecoveryandmaximisepotential

zz usearangeofcommunicationresourcesandapproachestoensurethatpatientsandtheircarersarefullyinvolvedinthedecision-makingprocessandtheircare

zz provideaclient-centredapproachtocareandmanageanychallengingbehaviour

In addition, take into account the skills and abilities required under 13.Long-termcare and 14.Review.


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1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-life care12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Returntowork

11 End-of-life care


zz Assessmentzz Preliminarydiagnosis/decisionzz Investigationzz Treatment/management�z Allcaresettings�z Deliver,whereverpossible,preferredplaceofcare�� Home�� Hospital�� Institution

zz Referraltootheragenciesandserviceszz Communication


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11 End-of-life care

Knowledge and understanding of…zz end-of-lifecarestrategies,advanceddirectives,andpalliativecaretoolsinrelationtostrokezz theimplicationsoftheMentalCapacityActforstrokepatientszz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousand

culturalaspirationszz therangeofsupportgroupsandservicesforthoseaffectedbystrokewithpalliativecareneedszz theneedsandaspirationsofthoseaffectedbystroke(i.e.patient,carerandfamily)zz theassessmentandmanagementofproblems,howtheycanbecontrolledandtheimplicationsforprognosis:

psychologicalandemotional;socialandrelationship;cognitiveandcommunication;physiological,physicalandfunctional;neurological,visualandsensoryimpairmentsandpain;medical

zz pharmacologicalandnon-pharmacologicalinterventionsforend-of-lifecareafterstrokezz thesideeffectsofpharmacologicalandnon-pharmacologicalinterventionsforend-of-lifecareafterstroke


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11 End-of-life care


possible,andassessmentalcapacityzz determine,planandinitiateappropriateassessments/investigationsandinterventions/treatments;provide

information,relevanttoindividualneedsandaspirations(personaliseinformation)zz communicateanddiscuss:currentevent;interventions/treatmentsandtheirtimeframes;rationalefor

treatment;possiblesideeffectsoftreatment;andprovideadviceandprognosiszz assesscapacityand“bestinterests”accordingtothestatutoryprincipleszz providesufficientinformationtoenableinformedchoiceanddecisionmakingbythoseaffectedbystrokezz identifyneedandwhentoreferformorespecialistordifferingtreatmentswherenecessary:agreereferralzz recogniseandmanagesymptomstakingaccountofindividualneedsandaspirationszz usepalliativecare,orotherrelevanttoolsandcarepathwayszz identifylocalservicesandresources,includingwaitingtimesandimplicationsforthoseaffectedbystrokezz usestrategiestohelpwithbreakingbadnews,managingemotionsandobtaininginformationonadvanced

directiveszz developmechanismstosupportthepalliativecareteamandprovideopportunitiesfordebriefingsessions



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zz Assessmentzz Preliminarydiagnosis/decisionzz Investigationzz Treatment/management�z Personandfamily-centredassessmentandmanagementplan

zz Referraltootheragenciesandservices(smoothandseamlesspathwayofcareacrossandbetween)zz Communication

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamless transfer of care13.Long-termcare14.Review15.Participationincommunity16.Returntowork


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Knowledge and understanding of…zz theassessmentandmanagementofproblems:psychologicalandemotional;socialandrelationship;cognitive

andcommunication;physiological,physicalandfunctional;neurological,visualandsensoryimpairmentsandpain;medical;andhowtoinvolveusersandcarers

zz advocatesforstrokepatientswhenthereisalegaldutytoinstructanIMCA,takingaccountofreligiousandculturalaspirations

zz theimplicationsofstrokeforlifestyle,driving,workandfamilyzz methodstofacilitatecommunicationwiththoseaffectedbystrokezz supportservices,organisationsandresourcesavailable(e.g.health,social,voluntary,independentsector;

packagesofcare,financeandpersonalbudgets,self-management,respitecare,equipment,adaptations,rehabilitation,psychological,educational,employment,housing,transport)includingexitstrategies

zz theprinciplesofgoodplanningfortransitionbetweenservicesorcessationofservicesandfortransferofcaretothecommunity,includingtheeducationofthoseaffectedbystroke

zz allagenciesthatarepotentiallyinvolvedalongthewholeoftheStrokePathwayzz theprinciplesofmulti-agencyworking

In addition, take into account the knowledge and understanding relating to 3.Information; 4.Userinvolvement and 10.Specialistrehabilitation.


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possible,andassessmentalcapacityzz determine,planandinitiateappropriateassessmentsandtreatments;provideinformation,relevantto

individualneedsandaspirations(personaliseinformation)zz assess,discussandreviewwiththoseaffectedbystroke:goal-setting,outcomesandexitstrategieszz monitorprogressandagreeorchangeamaintenanceormanagementplanzz identifyneedandwhentoreferformorespecialistordifferingtreatmentswherenecessaryzz identifylocalservicesandresources(e.g.health,social,voluntary,independentsector;equipmentand

adaptations,rehabilitation,psychological,educational,employment,housing,transport)tofacilitateparticipationandinclusion:checkavailabilityandwaitingtimes;informindividualaboutservices,identifyhowtoaccess,orre-access,themandagreereferral

zz liaisewithandworkacrossagencieszz identifyandutiliseresourcesavailablelocallyandnationallytosupportthoseaffectedbystrokezz reflectonprocessesandpathwaysofcareincludingmechanismsforreviewandexitstrategieszz reflectonmethodsandeffectivenessofinformationsharing

In addition, take into account the skills & abilities required under 3.Information.



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1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-term care14.Review15.Participationincommunity16.Returntowork

13 Long-term care and support


zz Assessment�z Personandfamily-centredassessmentandmanagement

zz Preliminarydiagnosis/decisionzz Investigationzz Treatment/management�z Secondaryprevention�� Health�� Socialcare�� Respite�� Equipment

�z Adaptations�z Secondaryprevention�� Lifestyle�� Concordance(e.g.ensurethatthepatienttakesmedication,attendstherapysessions)

zz Referralandre-referraltootheragenciesandserviceszz Communication


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andcommunication;physiological,physicalandfunctional;neurological,visualandsensoryimpairmentsandpain;medical


zz theneedsandaspirationsofthoseaffectedbystroke,particularlythoserelatedtotheproblemslistedabove,andhowtheseneedsandaspirationscanbemet

zz theimpactofstrokeontheindividual,carerandfamilyzz theimplicationsofstrokeforlifestyle,driving,workandfamilyzz riskfactorsforfurthervascularevents(e.g.typeandaetiologyofcurrentevent,lifestyle,socioeconomic,

cultural,vascular,familial,genetic,concurrentmedications,comorbidities)zz pharmacologicalandnon-pharmacologicalinterventionsforsecondarypreventionandtofacilitaterecovery

afterstrokeandtheirsideeffectszz supportservices,organisationsandresourcesavailable(e.g.health,social,voluntary,independentsector;packages

ofcare,financeandpersonalbudgets,self-management,respitecare,equipment,adaptations,rehabilitation,psychological,educational,employment,housing,transport)

zz assistivetechnologyandothertherapyinterventions(e.g.functionalelectricalstimulation,orthotics)zz methodstofacilitatecommunicationwiththoseaffectedbystrokezz concordance:howtoassess;howitisaffectedbyindividualpreference;howtomotivate;howtomanage

non-concordance

In addition, take into account the knowledge and understanding relating to 2.Managingrisk; 5.Assessment(TIA); 6.Treatment(TIA) and 10.Specialistrehabilitation.



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possible,andassessmentalcapacityzz communicateanddiscuss:currentevent;riskoffuturevascularevent;needforassessments/investigations,

interventions/treatmentsandtheirtimeframes;rationalefortreatment;possiblesideeffectsoftreatment;andprovidetimelyinformation,adviceandsupport

zz monitortheindividual’sprogressandagreeorchangeamaintenanceormanagementplanzz assess,discussandreviewwiththoseaffectedbystroke:goal-settingandoutcomeszz identifyneedandwhentoreferformorespecialistordifferingtreatmentswhennecessaryzz identifyrelevantrehabilitationandsocialsupportservicesafterdischarge:informtheindividualaboutservices

andhowtoaccessthemandagreereferralzz identifytheindividual’smotivationandtakestepstomodifybehaviourzz knowoflocalservices,theirwaitingtimesandimplicationsforthoseaffectedbystrokeandensurethatthe

individualisawarezz understandhowthoseaffectedbystrokecanbeempowered(e.g.throughself-managementprogrammes)zz assessandfacilitateconcordance


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14 Review


zz Assessment�z Personwhohashadthestrokereview�z Specialistreview�z Information�z Support�z Rehabilitation

zz Preliminarydiagnosis/decisionzz Investigationzz Treatment/management�z 6weekreview(post-discharge)and�z 6monthand�z Annual

zz Communication



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14 Review





zz supportservices,organisationsandresourcesavailable(e.g.health,social,voluntary,independentsector;packagesofcare,financeandpersonalbudgets,self-management,respitecare,equipment,adaptations,rehabilitation,psychological,educational,employment,housing,transport)

zz theimpactofstrokeontheindividual,carerandfamilyzz theimplicationsofstrokeforlifestyle,driving,workandfamilyzz riskfactorsforfurthervascularevents(e.g.typeandaetiologyofcurrentevent,lifestyle,socioeconomic,

cultural,vascular,familial,genetic,concurrentmedications,comorbidities)zz pharmacologicalandnon-pharmacologicalinterventionsforsecondarypreventionandhowtohelprecovery

afterstrokezz sideeffectsofriskfactorinterventionsandtreatmentstohelpwithrecoveryafterstrokezz methodstohelpcommunicationwiththoseaffectedbystrokewhenconductingareviewzz concordance:howtoassess;howitisaffectedbyindividualpreference;howtomotivate;howtomanagenon-

concordance

In addition, take into account the knowledge and understanding relating to 2.Managingrisk; 5.Assessment(TIA); 6.Treatment(TIA) and 10.Specialistrehabilitation.


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14 Review




zz monitortheindividual’sprogressandagreeorchangeamaintenanceormanagementplanzz assess,discussandreviewwiththoseaffectedbystroke:goal-settingandoutcomeszz planassessmentsandtreatments;provideinformation,relevanttoindividualneedsandaspirations(personalise

information)

zz identifyneedandwhentoreferformorespecialistordifferinginterventions/treatmentswherenecessaryzz reviewprocessinyourareaandactonthereviewzz assessandfacilitateconcordanceIn addition, take into account the skills and abilities required under10.Specialistrehabilitation.



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15 Participation in community life


zz Assessment�z Personandfamily-ledassessmentandmanagement�z Specialistreview�z Information�z Support�z Rehabilitation

zz Preliminarydiagnosis/decisionzz Investigationzz Treatment/Management�z Provisionof�� equipment�� adaptations

zz Communication

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participation in community16.Returntowork


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zz supportservices,organisationsandresourcesavailable(e.g.health,social,voluntary,independentsector;packagesofcare,financeandpersonalbudgets,self-management,respitecare,equipment,adaptations,rehabilitation,psychological,educational,employment,housing,transport)

zz theimpactofstrokeontheindividual,carerandfamilyzz theimplicationsofstrokeforlifestyle;driving;work,includingvoluntaryandfamilyzz methodstohelpcommunicationwiththoseaffectedbystroke,includingwhenconductingareview



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zz assess,discussandreviewwiththoseaffectedbystroke:goal-settingandoutcomeszz monitortheindividual’sprogressandagreeorchangeamaintenanceormanagementplanzz planassessmentsandtreatments;provideinformation,relevanttoindividualneedsandaspirations(personalise

information)zz identifyneedandwhentoreferformorespecialistordifferingtreatmentswherenecessaryzz knowoflocalservices,theirwaitingtimesandimplicationsforthoseaffectedbystrokeandensurethatthe

individualisawarezz useindividualcommissioning


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16 Return to work


zz Assessment�z Identifyrelevantindividuals�z Personcentred�z Specialistassessment�z Information�z Support�z Rehabilitation

zz Preliminarydiagnosis/decision�z Investigations�� Visual�� Cognitive�� Physical�� Sensory

zz Treatment/management�z Home�z Hospital�z Educationinstitution

1. Awarenessraising2. Managingrisk3. Information4. Userinvolvement5. Assessment(TIA)6. Treatment(TIA)7. Urgentresponse8. Assessment(stroke)9. Treatment(stroke)10.Specialistrehabilitation11.End-of-lifecare12.Seamlesstransferofcare13.Long-termcare14.Review15.Participationincommunity16.Return to work


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16 Return to work

Service required (continued)�z Workplace�z Community

zz Referraltootheragencies�z Accesstostrokespecialistvocationalrehabilitation�z Worksite/placeassessment�z Jobanalysis�z Workhardening�z Returntoworkplanning�z Goalsettingforworkreturn/retention�z Riskassessment�z Benefitsadvice�z Workreview�z Provisionof�� equipment�� adaptations

zz Communication�z Returntoworkeducation�z Liaisonwithemployers/educatorsandotheragencies


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16 Return to work

Knowledge and understanding of…zz theeffectsofstroke(cognitive,physical,sensory,visual,emotional,confidence)andhowitmayaffectareturn

toworkand/oreducationzz assessingtheeffectsofstroke(cognitive,physical,sensory,visual,emotional,confidence)zz employmentlaw,theDisabilityDiscriminationAct,healthandsafetyatworkzz therolesofhealthcareandotherprofessionalsinemployment-relatedservices(occupationalhealth,

occupationalpsychologist,disabilityemploymentadviser)zz theoccupationaltherapist’sroleinvocationalrehabilitationzz JobcentrePlus,itsservicesanditseffectivenessforstrokezz whatismeantby“reasonableadjustment”intheworkplace,howtoadaptorinstigateadaptationtothework

environmentandtheemployer’sresponsibilityzz availablehelpfultechnologyforovercomingfunctionalandactivitylimitationsintheworkplacezz ergonomicprinciplesandhowtoovercomeaccessissueszz returntoworkeducationzz health,workandwell-being–theroleofpurposefuloccupationandthedetrimentaleffectsofworklessnesszz thebenefitssysteminrelationtoworkzz workplaceassessmentincludingrisk,jobanalysis,workhardening,returntoworkplanningandjobretentionzz modelsofvocationalrehabilitationforstrokeandvocationalcasemanagementzz vocationalrehabilitationguidelinesandstandardsforpeoplewithstroke(BritishSocietyofRehabilitation

Medicine;VocationalRehabilitationAssociation;UKRehabilitationCouncil)


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16 Return to work

Skills and ability to…zz refertoavocationalrehabilitationservicezz assessorreferfortheassessmentofvisual,cognitive,functionalandphysicaldeficitsfollowingstrokezz identifylocalandnationalservicesforreturntowork,theiravailabilityandhowtheycanbeaccessedzz knowwhichprofessionalspeopleshouldbereferredtoforemployment-relatedserviceszz assessfor,adviseonandreviewtheneedforworkplaceadaptationzz assessfor,adviseonandreviewtheneedforassistivetechnologyandenvironmentaladaptationstoovercome

work-relatedactivitylimitationszz withastrokesurvivor,advise,prepareandplanareturntoworkoreducationandhowtheycanbesupported

onthereturntoworkpathwayzz adviseemployers/educatorsaboutstrokeanditseffectsandnegotiateareturntoworkofthestrokesurvivorzz communicatestroke-relateddeficitstoemployers,colleagues,educators,familymembersandfriendszz givebenefitsadviceorreferzz carryoutaworkplaceassessmentandriskassessment,orreferzz carryoutjobanalysis,orreferzz setgoalsforworkreturn/retentionzz casemanageandrefertoacasemanagementserviceforareturntoworkafterstrokezz implementguidelinesinpracticezz helpthestrokesurvivortoremaininwork,reviewthestrokesurvivoratwork/ineducationandadviseon

workplaceaccommodations



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Project teamCarolineWatkinsPamScoularMichaelLeathley

Steering group membersClareAdamsSandraAitchesonSarahBazinDavidBrittDuncanCampbellPeterColemanMonicaFletcherIanGoltonDamianJenkinsonPradeepKhannaFleurKitselWendyMageeChristopherPriceChristineRoffePamScoularMargaretSomervilleCarolineWatkinsRogerWatsonJaneWilliams

Task groups’ membersTraceyBarronChrisBurtonRobinCantPeterColemanTomConyersDavidDavisNicolaDavisAndrewDowsonSarahEastonMonicaFletcherClaireFullbrook-ScanlonKateGarasIanGoltonDawnGoodMayGriffithsPhilippaHardyVishyHariharaKatherineHendersonJillHigginsHelenHoskerJanetIveyMikeJacksonSaraJoiceJasonKendallIanKneeboneJoeKornerFionaLunnRonMacWalterWendyMagee

Task groups’ members (continued)TerryMearsSaraMooreClaireMoserChristineParker-JonesEnidPoveyChrisPriceTomQuinnKathrynRadfordNaghmanaRiazuddinHelenRodgersChristineRoffeAlasterRutherfordIanScottRobinSellarHamsarajShettyFionaShieldsMauriceSmithAdrianSouthNeilSpencerGaneshSubramanianCaronTaylorJanVaughanJaneWainwrightKarenWalkerSueWayneAndyWilliamsJaneWilliamsElaineYardley

stroke-specific education framework - nhs wales€¦ · stroke-specific knowledge and skills which...

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