Download - PENS Leadership - EXCEMED
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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
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Introduction • Paediatric Endocrine Nurse Roles
• Roles of Clinical Nurse Specialists
• Paediatric Endocrine Nurses Competency
Framework
• Advancing clinical roles
• Education for
paediatric
endocrine
nurses
• ESPEN
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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
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Clinical nurse
specialist
Consultant
Educator
Researcher
Collaborator
Leader
Change Agent
Patient
advocate
Liaison
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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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
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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..
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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
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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
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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
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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
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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
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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
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Nurse led general paediatric endocrine
clinic in a general hospital – specialist
centre
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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
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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
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Proformas for clinic • Premature adrenarche
• Premature thelarche
• PWS
• Turners syndrome
• CAH
• CPP
• Congenital
hypothyroidism
• GH administration
training
• GH choice
• IM HC training
• Panhypopituitarism
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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
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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
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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
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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
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Children’s Advanced Nurse Practitioner
• 3 year MSc course
• Accredited by the RCN
• Specialising in specific fields
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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
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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
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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
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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
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Non Medical Prescriber • Autonomous practitioner
• Able to prescribe from British National Formulary o Within field of competence
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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.