professional practice for exercise referral instructors … · professional practice for exercise...

Learner name:

Learner number:

Y/503/7493

VRQ

UV31357

Professional practice for exercise referral instructors

By signing this statement of unit achievement you are confirming that all learning outcomes, assessment criteria and range statements have been achieved under specified conditions and that the evidence gathered is authentic.

This statement of unit achievement table must be completed prior to claiming certification.

Unit code Date achieved Learner signature Assessor initials

IV signature (if sampled)

Assessor name Assessor signature Assessors initials

Assessor number (optional)

Assessor tracking table

Statement of unit achievement

All assessors using this Record of Assessment book must complete this table. This is required for verification purposes.

VTCT is the specialist awarding body for the Hairdressing, Beauty Therapy, Complementary Therapy, Hospitality and Catering and Sport and Active Leisure sectors, with over 45 years of experience.

VTCT is an awarding body regulated by national organisations including Ofqual, SQA, DfES and CCEA.

VTCT is a registered charity investing in education and skills but also giving to good causes in the area of facial disfigurement.

UV31357Professional practice for exercise referral instructors

The aim of this unit is to develop your knowledge and understanding of accepted professional practice for exercise referral instructors, including related policies, risk stratification and roles and responsibilities within an exercise referral scheme.

You will learn about the importance of exercise referral, current healthcare systems/policies in the UK and the exercise referral process. Furthermore, you will explore successful exercise referral schemes.

UV31357_v6

GLH

Credit value

Level

Observation(s)

External paper(s)

14

2

3

0

0

On completion of this unit you will:

Learning outcomes Evidence requirements

Professional practice for exercise referral instructors

1. Understand the role and importance of exercise referral, related policies and key documents

2. Understand roles and responsibilities within an exercise referral scheme

3. Understand the current healthcare systems in the UK

4. Understand the exercise referral process

5. Understand the principles and procedures of record keeping

6. Understand the concept of a patient-centred approach

7. Understand how to monitor a successful exercise referral scheme

8. Understand the principles of risk stratification in exercise referral

1. Knowledge outcomes There must be evidence that you possess all the knowledge and understanding listed in the Knowledge section of this unit. In most cases this can be done by professional discussion and/or oral questioning. Other methods, such as projects, assignments and/or reflective accounts may also be used.

2. Tutor/Assessor guidance You will be guided by your tutor/assessor on how to achieve learning outcomes in this unit. All outcomes must be achieved.

3. External paper There is no external paper requirement for this unit.

UV31357 3

Achieving knowledge outcomes

Developing knowledge

You will be guided by your tutor and assessor on the evidence that needs to be produced. Your knowledge and understanding will be assessed using the assessment methods listed below*:

• Projects• Observed work• Witness statements• Audio-visual media • Evidence of prior learning or attainment• Written questions• Oral questions• Assignments• Case studies• Professional discussion

Where applicable your assessor will integrate knowledge outcomes into practical observations through professional discussion and/or oral questioning.

When a criterion has been orally questioned and achieved, your assessor will record this evidence in written form or by other appropriate means. There is no need for you to produce additional evidence as this criterion has already been achieved.

Some knowledge and understanding outcomes may require you to show that you know and understand how to do something. If you have practical evidence from your own work that meets knowledge criteria, then there is no requirement for you to be questioned again on the same topic.

*This is not an exhaustive list.

UV313574

Knowledge

Outcome 1

Understand the role and importance of exercise referral and related policies and key documents

You can: Portfolio reference

a. Explain the role of exercise referral in both the fitness industry and the health sector

b. Evaluate the general role of exercise in disease risk reduction and condition management

c. Outline the key points of government policies relating to exercise referral schemes

d. Outline key points from the Professional and Operational Standards for exercise referral

UV31357 5

Outcome 2

Understand roles and responsibilities within an exercise referral scheme


a. Explain the roles of the medical, health and fitness professionals in an exercise referral scheme

b. Define the fitness professionals scope of practice and the inter-professional boundaries within an exercise referral scheme

c. Describe how to deal with a patient who has a medical condition outside the scope of practice of the exercise referral instructor

d. Explain when to refer to other professionals including the original referrer

e. Explain how to determine ‘inappropriate referrals’

f. Explain the importance of not accepting a patient who has been declined a referral for exercise from their medical practitioner or health professional

g. Explain the importance of effective inter-professional communication

UV313576

Outcome 3

Understand the current healthcare systems in the UK


a. Describe the role of Clinical Commissioning Groups

b. Identify key health service documents/policies and their impact on the healthcare system in relation to exercise referral

UV31357 7

Outcome 4

Understand the exercise referral process


a. Explain the process of receiving a referred patient from a healthcare professional

b. Describe the protocol for an initial patient consultation with the exercise referral instructor

c. Describe the principles of patient monitoring and data collection

d. Outline the medico-legal requirements relevant to the exercise referral instructor job role

UV313578

Outcome 5

Understand the principles and procedures of record keeping


a. Explain how patient confidentiality is maintained in an exercise referral scheme

b. Explain the concept of data protection

c. Explain the meaning of validity and reliability in relation to measurement of techniques and outcomes

d. Explain how to evaluate the quality and reliability of evidence

UV31357 9

Outcome 6

Understand the concept of a patient-centred approach


a. Explain how verbal and non-verbal communication, appearance and body language can influence patients’ perception

b. Describe a range of consulting skills

c. Explain the term ‘health behaviours’

d. Explain locus of control

UV3135710

Outcome 7

Understand how to monitor a successful exercise referral scheme


a. Describe techniques to monitor success for the patient and the scheme

b. Describe the importance of monitoring and evaluation in exercise referral

UV31357 11

Outcome 8

Understand the principles of risk stratification in exercise referral


a. Describe the principles of risk stratification

b. Explain the current use of risk stratification tools used in exercise referral

UV3135712

Outcome 1: Understand the role and importance of exercise referral and related policies and key documents

Unit content

This section provides guidance on the recommended knowledge and skills required to enable you to achieve each of the learning outcomes in this unit. Your tutor/assessor will ensure you have the opportunity to cover all of the unit content.

UV31357 13

Role of exercise referral: Use of exercise as part of a person’s treatment plan, intervention, management of condition, decrease speed of deterioration of health.

Role of exercise in condition management: Disease risk reduction, condition management, reduction of clinical signs/symptoms, benefits (physical, psychological, physiological).

Key points of government policies in relation to exercise referral schemes: Recognition of government policy, awareness of policy changes, new resources, familiarity with the context for policy, consideration for how policy is translated to client, understanding how policy impacts on role and responsibilities.

Key points from the professional and operational standards: Exercise referral advisory group (ERAG 2011), reassure patient of the specific standards, compliance with quality assurance (NQAF), defined scope of practice for all persons involved, patient-centred model, consideration of appropriate methods of delivery.

Outcome 2: Understand roles and responsibilities within an exercise referral scheme

UV3135714

Roles of medical and health professionals: Refer patients into quality assured system, maintain clinical responsibility, transfer of information to scheme manager/co-ordinator and exercise professional.

Role of health promotion lead/scheme manager: Set up scheme, establish connections/working partnerships, ensures policies, protocols, procedures in place, recruits/selects appropriately qualified exercise professionals (provides opportunities for continuing professional development (CPD)), ensure scheme is aligned to national standards/industry codes of practice (Fitness Industry Association (FIA)).

Role of scheme co-ordinator/manager: Assignment of patient to exercise professional, referral back to GP/health professional (inappropriate referrals), may be responsible for initial patient assessment, maintain appropriate records, monitor progress and effectiveness of scheme, provide records to GP/health professional.

Role of exercise professional: Work within scope of practice, inter-professional boundaries, working with others, reporting channels, roles include initial assessment (information may come from scheme co-ordinator), referral back to scheme co-ordinator/GP, gain informed consent, responsibility for exercise programme (safe and effective management, design, delivery), act professionally, motivate and support patient, maintain confidentiality, comply with legislation, maintain accurate records, qualified to appropriate levels, member of register of exercise professionals (REPs), not responsible for medical diagnosis, counselling of patient, nutrition or dietary advice.

Patients outside the scope of practice of exercise referral instructor: Referral back to the GP/referrer, based on interview responses, medical history, assessment of contra-indications, avoidance/adaptation around the problem, sound judgment call, consideration of client options.

When to refer to other professionals: Outside of scope of practice, inappropriate referrals, confusion regarding nature of referral, missing information, omissions, inaccuracies, ‘new’ information is forthcoming, including the original referrer.

Determining inappropriate referrals: Persons at high risk (current severe disease or disability), acceptance/inclusion (determined by availability of resources), conversation with service lead/manager/GP, paperwork from health consultation, testing results, data, informal conversations with patient, missing/inaccurate information.

Importance of not accepting patients who have been declined a referral for exercise: Breach of inter-professional boundaries, breach of duty of care to client, patient may need other specialist care (exercise may not be appropriate), outside scope of practice, may put patient at risk, place the exercise professional/organisation at risk prosecution, negative impact on reputation of exercise and fitness industry/exercise referral, destroy potential for future collaboration (exercise and health professionals).

Importance of effective inter-professional communication: Roles clarified (limits defined), awareness of boundaries, framework for promotion of trust and respect, promotes confidence, positive experience for patient, successful working alliances (efficient/effective), transfer/storage of patient

Outcome 2: Understand roles and responsibilities within an exercise referral scheme (continued)

UV31357 15

records (meet legal requirements), breach of patient confidentiality, when confidentially may be breached (e.g. deterioration or change of symptoms, non-compliance with medication).

Outcome 3: Understand the current healthcare systems in the UK

Role of clinical commissioning groups: Practice-based commissioning (PBC), hold power to control how money is spent, impactful and accountable (on financial and political level), growth of health and wellbeing boards, link between commissioning and evaluation of schemes, aspects of good practice, understanding the impact of outcomes and identifying which outcomes are important, notion of ‘shared outcomes’ (working in partnership), connection between commissioning and the instructor’s role, avoidance of ‘revolving door’ approach.

PBC and exercise referral: Potential/actual savings from scheme, impact of cost savings, savings in other areas of health care expenditure (e.g. medication, visits to GP, support/care workers), concept of return on investment, select to commission/ work with operators/service providers who provide evidence of best practice/value for money.

Department of health (DoH) vision for PBC: Ensure a greater variety of services from greater number of providers, services in setting that are close to home/more convenient to patients, bring decision making process closer to communities, efficient use of services, involve front line

doctors and nurses in commissioning decisions.

Key health service documents/polices: For example, annual reports from Directors of Public Health, National Quality Assurance Framework (NQAF), Public Health Outcomes Framework, Fitness Industry Association (FIA), DoH guidelines for activity, Loughborough University (guidelines for sedentary client care), impact on healthcare system.

Outcome 4: Understand the exercise referral process

UV3135716

Process that the referring health professional will undertake:

Inclusion/exclusion criteria – types of clients’ scheme can accept/work with, determined by experience/qualifications of exercise professionals, low risk, high risk, risk stratification.

Transfer of information – information (physical activity readiness questionnaire (PAR-Q)), physical activity readiness medical examination (PARmed-X), how information will be passed between health professional and exercise professional, transfer of information record, gain informed consent.

Contact – transfer information (named contact, scheme co-ordinator).

Process of exercise professional receiving referred patient:

Scheme co-ordinator – check information, seek clarification if needed, refer back if any information is not available, contact client, arrange initial consultation.

Information transfer record (to include) – client’s personal details, date, reason for referral, past/present medical history, medications, other treatments, risk stratification (PAR-Q, PARmed-X, risk stratification tools), language, religious, cultural needs, preferred method of contact, health measurements (blood pressure, body mass index (BMI)).

Agreed level of communication – between exercise and health professional, specified intervals, report on (clients adherence, progress, regression, any changes identified).

Protocol of initial patient consultation: Meeting between client and exercise

professional, build rapport, lay foundations for positive relationship, identify most appropriate way to help and support (activity/exercise intervention, other services e.g counseling, dietician etc.), explain the referral process, ensure understanding, obtain informed consent to participation, assess readiness to exercise, establish goals (short, medium, long term), likes and dislikes, development of safe/effective programme (using FITT principles), development of individualised programme.

Principles of patient monitoring and data collection:

Patient monitoring – ongoing, before every session, attendance, re-assess readiness to participate, monitor any changes (from initial consultation, previous session), response to previous session (e.g. excessive tiredness, discomfort, chest pain), results of any medical appointments/tests.

Data collection – current health status, medications, social factors, levels of motivation, goal setting, physical activity levels, height, weight, BMI, resting/pre-exercise heart rate, resting blood pressure etc.

Medico-legal requirements for the exercise referral job role: Adequate insurance (personal and organisational), appropriate qualifications (context and level), avoidance of litigation, compliance with NQAF, local policies and guidelines, service level agreements, accountability and individual responsibilities of patient/practitioner and referrer in the process.

Outcome 5: Understand the principles and procedures of record keeping

UV31357 17

Maintaining patient confidentiality: Importance and relevance, litigation, local procedures, understanding of information processing and sharing procedures, reasons to breach confidentiality.

Data protection: Information governance (mandatory training for local education authority (LEA)/statutory body/providers if on contract), quality and standards, impact of getting the process wrong, data sharing and compliance with the data protection legislation.

Validity and reliability of measurement techniques and outcomes: Prevention or minimisation of error, feedback appropriate and accurate, measurement precision.

Evaluate the quality and reliability of evidence: Understanding information quality and recognition of where information is sourced from, use of materials which are within scope of guidance.

Outcome 6: Understand the concept of a patient-centred approach

UV3135718

Patient-centred approach: Patient best expert on themselves, patients in correct environment (make right choices for themselves, find right solution to own problems), correct environment (core conditions, unconditional positive regard, empathy, congruence are present), patient takes responsibility for deciding/undertaking change, exercise professional is a facilitator (use communication and skills to raise clients awareness of own power), client leads and directs the process.

Verbal and non-verbal communication and influence on patients’ perception: Interpersonal skills, rapport building, patient empathy, mirroring, tone of voice, eye contact, appearance and body language.

Consulting skills: Empathy, unconditional positive regard, congruence, non-judgmental, professionalism, skills of facilitation, knowledge of motivational interview techniques, awareness of psychological state of change, appreciation of client preferred communication style, solution-focused therapy, patient input, active listening, reflecting and paraphrasing, multi-culturalism and diversity, appreciation of social situation, emphasis on positives, assets-based approach.

Health behaviours: Lifestyle activities that patients engage in, choices they make (activity levels, diet, smoking, substance use, health screening checks, sexual behaviour), may be determined by belief systems, socio-economic background, peer pressure and media.

Locus of control: Extent to which individual believes in power to influence through own actions, internal locus of

control (believe power to make change), external locus of control (‘fatalisitic’, believe life is chance and luck), self-efficacy, appreciate personal lifestyle context and constraints, self-management of condition(s) and personal wellbeing.

Outcome 7: Understand how to monitor a successful exercise referral scheme

UV31357 19

Techniques to monitor success: Attendance, pedometers, review of goals (achievement/progress), physical assessments, programme cards (progressions, regression), psychological assessments (mood, energy levels, quality of life), medical records, diaries/logs, lifestyle changes.

Techniques to ensure success: Ensure goals have been set, action planning, awareness of ‘risk time’ (e.g. responsive to patient adherence and general behaviour), consideration of barriers, understanding difference between measuring success linked to outcome and impact and success by ‘input’), needs to be outcome focused.

Importance of monitoring and evaluation: Informing intelligent and relevant commissioning, link to commissioning targets, relationship with commissioners and input towards provision and outcomes, monitoring progress, motivation, increasing adherence, prompt and timely record keeping and paperwork submission, programme audit.

Outcome 8: Understand the principles of risk stratification in exercise referral

Principles of risk stratification: Assigning of patient to specific category, estimation of risk attached to being active, identify persons at increased risk of exercise/exertion related incident (specific to disease, risk factor, medical condition), classified (low, moderate, high risk), information from referrer, consideration of risk based on accepted policy or published guidelines.

Objectives of risk stratification: Identify persons at risk, assist with exercise prescription/recommendations, enable development of informed safe, effective programmes, identify appropriate level of monitoring/supervision.

Risk stratification tools used in exercise referral: National Quality Assurance

Framework (NQAF, 2001) for exercise referral, American College of Sports medicine (ACSM), National Occupational Standards (SkillsActive), BHF National centre for Physical Activity and Health Exercise Referral tool kit (2010), Fitness Industry Association (FIA), Exercise Referral Advisory Group.

UV3135720

Notes Use this area for notes and diagrams

professional practice for exercise referral instructors … · professional practice for exercise...

Documents