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Working together to achieve the healthiest life possible for everyone in Ayrshire and Arran Candidate information pack Visit our website: www.nhsaaa.net All our publications are available in other formats Find us on Facebook at www.facebook.com/nhsaaa Follow us on Twitter @NHSaaa Post Title: Associate Practitioner Job Reference Number: T/711/15 Informal Enquiries: Informal enquiries are welcomed by: Fiona McMillan, Head of Clinical Physiology who can be contacted on 01292 617102 Closing Date: Monday 29 February 2016 Process for Submitting Application Form: You can apply using the online application form on the SHOW website – www.jobs.scot.nhs.uk Alternatively your completed application form can be returned to [email protected] or to the Department of O&HRD, 63A Lister Street, University Hospital Crosshouse, Kilmarnock, KA2 0BE Please note: if applying using the online application facility on the SHOW website, the text in the supporting statement section is limited and overlong statements may be cut off. Please try to limit this section to the length of two A4 pages. All correspondence will be sent by email. We have experienced some issues with personal email addresses and there is no guarantee correspondence will be sent to your inbox. It is therefore your responsibility to check all email folders, including your junk folder, as we have no control over which folder the correspondence will be sent to. Section one: Why work in Ayrshire? Ayrshire is situated in the south-west of Scotland on the Firth of Clyde, and is characterised by 80 miles of varied coastline, picturesque beaches, rolling green hills and islands. Just a 30-minute drive from Glasgow city centre, Ayrshire is an ideal location for those who want to enjoy city life, with all the benefits of living in a semi-rural area. Ayr, Irvine and Kilmarnock are the largest towns. However, there are many rural towns, villages and communities throughout the area should you wish to relocate to Ayrshire. Whether you decide to locate to Ayrshire or a neighbouring area, you will find that property prices are more affordable than in other parts of the UK. Alternatively, working in Ayrshire provides an easy commute from both Glasgow and the wider central belt. There is an excellent network of both rail and bus links throughout Ayrshire to Glasgow and beyond. There are UK and international flights available from Glasgow Airport, as well as a range of services from Glasgow Prestwick Airport. Ayrshire provides a wide range of excellent recreational activities: whether you are interested in history and heritage, outdoor pursuits, events and festivals, or simply food and drink, there is something for everyone. Ayrshire boasts more than 40 quality golf courses, including two Open Championship courses at Turnberry and Royal Troon. For more information on the range of recreational activities in Ayrshire, visit www.visitscotland.com/ayrshire-arran Local educational standards are very high at primary and secondary level. However, private education is also available in the area. See below for more information on local authority services: East Ayrshire Council – www.east-ayrshire.gov.uk North Ayrshire Council – www.north-ayrshire.gov.uk South Ayrshire Council – www.south-ayrshire.gov.uk Section two: NHS Ayrshire & Arran as an employer NHS Ayrshire & Arran recognises that our staff are vital to delivering our purpose, values and commitments and to achieving our strategic objectives. Our purpose Working together to achieve the healthiest life possible for everyone in Ayrshire and Arran Our values Caring Safe Respectful Our aim is to create an organisation where people want to work and strive to deliver excellence each day; where staff wellbeing and personal resilience is supported; where careers are interesting and developed; where staff are encouraged to reach their full potential; and where staff feel their contribution is recognised and valued. To do this, we need to attract, develop, support and retain our staff and enhance their work experience. This will directly contribute to our aspiration to deliver excellent high quality services to every person every time. We believe the unique factors that help to define us as an employer are: our friendly and supportive environment; our commitment to staff engagement and effective team working; our track record in creativity and innovation and our ability to successfully implement change and redesign; our track record in supporting our staff’s learning, development and career aspirations, from an initial comprehensive three-day corporate induction programme to the availability of a wide range of internal training programmes; our commitment to supporting flexible working through a wide range of family friendly policies; and our commitment to support and improve our staff’s health, safety, wellbeing and resilience. We do this by implementing our Staff Health, Safety and Wellbeing Strategy, and in our work towards achieving and maintaining the Health Working Lives Gold Award. In addition, our Staff Care and Occupational Health Service provide a range of support and interventions to our staff. The organisation has a statutory responsibility to ensure the Staff Governance Standard is embedded and adhered to as part of the governance framework – staff, financial, information and clinical governance – in which NHS Boards operate. The Staff Governance Standard requires all NHS Boards to demonstrate that staff are: well informed; appropriately trained and developed; involved in decisions; treated fairly and consistently, with dignity and respect in an environment where diversity is valued; and provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients and the wider community. During 2013, we consulted with our staff to select the key values and behaviours which they believed were essential to create a safe, effective and person-centred working environment which benefits patients, staff and carers. This allowed us to develop our purpose, values and commitments. We passionately believe in creating a culture which is open, fair and just. Section three: Delivering our services Acute Services Emergency and elective hospital services are provided by our acute services, which includes inpatient, outpatient and day case care. There are two district general hospitals within Ayrshire: University Hospital Ayr and University Hospital Crosshouse. These hospitals provide a wide range of acute services: University Hospital Ayr University Hospital Ayr provides medical and surgical services on an inpatient, day case and outpatient basis. It is the main Accident and Emergency service for South Ayrshire. It provides a number of Ayrshire-wide services including Vascular Surgery, Ophthalmology and Audiology. University Hospital Crosshouse University Hospital Crosshouse provides medical and surgical services on an inpatient, day case and outpatient basis. It is the main Accident and Emergency service for East and North Ayrshire. Inpatient paediatrics, the Ayrshire Maternity Unit and the main Laboratories for Ayrshire are on the Crosshouse site. Community, mental health and learning disabilities services Following the introduction of Health and Social Care Integration, the operational delivery for the range of community healthcare services and mental health and learning disabilities services is through the newly created Health and Social Care Partnerships and the Integrated Joint Boards: East Ayrshire Health and Social Care Partnership North Ayrshire Health and Social Care Partnership South Ayrshire Health and Social Care Partnership Community Services General medical and dental services are provided throughout Ayrshire and Arran by general practitioners, dentists, community pharmacies and optometry practices. Community nurses, health visitors and Allied Health Professionals are all involved in providing care within our local communities. Out-of-hours general medical services are provided by Ayrshire Doctors On Call (ADOC) within the community. Mental health and learning disability services Inpatient mental health services, including the Intensive Psychiatric Care Unit, are largely delivered at Ailsa Hospital in Ayr with further mental health inpatient services provided at University Hospital Crosshouse Learning disability services are provided from Arrol Park in Ayr. Elderly mental health inpatient services are provided from Ayrshire Central Hospital in Irvine, and East Ayrshire Community Hospital in Cumnock. Community based services are provided throughout Ayrshire for the range of clinical groups: adults, child and adolescent, elderly and addiction services. For more information on the full range of clinical services provided by NHS Ayrshire & Arran, visit our website www.nhsaaa.net Section four: Investing for the future There are two major capital developments underway within NHS Ayrshire & Arran to ensure safe, effective and person centred care: Building for better care We are investing £27.5 million to provide fit for purpose front door services for University Hospitals Ayr and Crosshouse, in order to improve emergency and urgent care for patients who come to hospital for anything other than a scheduled appointment. North Ayrshire Community Hospital – Woodland View We are investing £47 million to provide a 206 en-suite bedroom integrated mental health and community facility, including older people’s long term care and rehabilitation. This development will bring together a full range of outpatient and inpatient facilities. Section five: Post Details 1. Job Identification Job Title: Associate Practitioner- Clinical Physiology Responsible to: Head of Clinical Physiology Department(s): Cardiac ,Respiratory ,Vascular Directorate: Medical Specialities Operating Division: General Hospitals Job Reference: T/711/15 No of Job Holders: Last Update : May 2009 2. Job Purpose The post holder will undertake a 2 year Academic and Clinical Training course leading to a University Diploma in Clinical Physiology and Associate Membership of the Society for Cardiological Science and Technology. Upon successful completion of training the post holder will be competent to undertake: Investigative diagnostic services to assess the functioning of the Cardiovascular and Respiratory systems within the Clinical Physiology service , To provide Diagnostic services within Cardiology To provide diagnostic services within the area Vascular services To provide diagnostic services within Respiratory Physiology. To provide diagnostic services within out reach Spirometry Clinics 3. Dimensions The service provides acute health care for the local population of Ayrshire and Arran. The post holder covers two locations, Ayr Hospital and Crosshouse hospital with out reach services to other hospitals within Ayrshire and Arran and to primary care facilities Location types include Coronary Care, Medical in-patients, Surgical in-patients for anaesthetic assessment and post op. A&E , Theatre reception and recovery, Day surgery and Endoscopy suite and theatre. Medical/Surgical out-patient, G.P. open access, Paediatric in-patients and out-patients High dependency and I.T.U ,Psycho-geriatric patients, Vascular In and Out patients. The patients would include Acute high dependency, terminally ill, high risk, severely traumatised, infectious, those with learning difficulties both paediatric and adults, mental illness (pre ECT.) acute stroke and stroke rehabilitation, post head injury, drug and alcohol dependants, chest patients, Acute Medical receiving. vascular patients, pre and post amputee, Within the remit of the post holder a proportion of the following investigations are carried out: 45,000 ECGs 1,000 Lung function tests 1,350 Peripheral Dopplers 1000 Ambulatory 24 Hour ECG recordings 500 Ambulatory BP recordings 4. ORGANISATIONAL POSITIONHead of Clinical Physiology Services Area Highly Specialist Physiologists Operational Lead Clinical Lead U/S Operational Manager/ Clinical Lead U/S Crosshouse Clinical lead Devices- Ayr Ayr Highly Specialist Physiologists Specialist Physiologists Physiologists This Post Assistant Practitioners 5. ROLE OF DEPARTMENT The department provides an investigative diagnostic service within the acute hospital setting for patients with known or suspected Cardiac Vascular or Respiratory disease. Within the department the post holder works across a range of diagnostic investigative procedures. The work may be undertaken in either or both Acute hospitals or in a community setting The procedures undertaken are used to diagnose the level of Cardiac, Vascular or Respiratory disease in a patients and optimise their treatment or management. For some patients this may be over a period of time by monitoring the progress or deterioration of the disease pattern Patients may be investigated on an emergency or elective basis. During periods of high patient activity , Clinical Physiology staff have to respond to the increased demand for investigation to ensure rapid patient diagnosis, treatment and subsequent prompt discharge on appropriate therapy and prioritise their clinical work appropriately The department works closely with clinicians in all specialities and provides Open Access service to General Practitioners. The department is instrumental in achieving Health Board targets Set by the Executive for Coronary Heart Disease and Stroke and in delivering the Managed Clinical Networks for CHD and Stroke 6. Key Result Areas As an independent practitioner 70% of the role: Recording and first line reporting of resting ECG , Peripheral Dopplers and Ambulatory BP recording Multi Modality Cardiac Arrhythmia monitoring and hook up Provides diagnostic Respiratory function assessment within acute and primary care Independently produces accurate records of clinical & technical data across Cardiology, Respiratory and Vascular Physiology services. Ensures correct patient identification, maintains an accurate procedure log for audit purposes Analyses data, formulates preliminary report for review by senior physiologist or physician. Recognises Life threatening data and acts with the required level of urgency Ensures diagnostic results are available for dispatch without delay. Carries emergency page at evenings and weekends for A&E and the acute wards and is the lone provider of the service at these times Responds to the emergency page during normal working hours and as part of the Cardiac Arrest team. Participates in Cardioversion Therapy , monitors and advises clinicians of changes in heart rate and rhythm. Deals with enquiries regarding investigation results. Recognises the requirements for patient confidentiality, determines the identity and status of the enquirer before divulging information Organises own workload within clinical sessions to ensure that patients are treated in an efficient and timeous manner Recognises and reports equipment malfunctions promptly ,where possible rectifies faults or removes equipment from service. Recognises faults with the equipment used and the effects this will have on data recorded. Responsible for safe use of equipment within their remit and for cleaning and sterilising equipment on a daily basis. As an Assistant working in support of Specialist, Highly Specialist Physiologists and Medical Staff Patient preparation & assisting lead physiologist during exercise tests Patient preparation and assisting lead physiologist during Tilt Table procedures Analysis of Ambulatory Monitors with supervision from lead physiologist Monitoring of physiological data during procedure, recognises variations to normal and informs lead physiologist. Contributes to the training and education of Assistant practitioners, trainee physiologists, clinical support workers and other HCPs. Performs general administrative duties, deals with patient and staff enquiries, retrieves results and conveys in appropriate language to HCPs Attends and contributes to multi disciplinary audit meetings 7a. Equipment and Machinery Hand held peripheral Doppler equipment used for the measurement of arterial function. Sphygmomanometer for the measurement of arterial blood pressure. Electrocardiograph machine used for recording patients’ heart rate and testing for any rhythm abnormalities. Hand held spirometer used for basic lung function volumes. Nebulisers used for the administration of Salbutamol. Blood pressures monitoring equipment used for the recording of blood pressure over a twenty four hour period. Cardiac monitoring equipment used for the recording of heart and rhythm over twenty four hours or more. PC based analyser for ambulatory ECG and BP clinical data Monitoring equipment during Exercise testing and Tilt testing Oxygen Saturation monitors Lung Function equipment for diagnosis of pulmonary disease using special gases such as Acetylene, Carbon Monoxide and Methane Defibrillator- for Cardiac arrest and Cardioversion of heart rhythm 7b. Systems Clinical data bases to input, amend, retrieve ,collate, audit patient diagnostic data Maintenance of manual patients records Patient administration system for making /amending appointments, tracking of clinical requests and reports All machines are PC based and therefore VDUs are used constantly 8. Assignment and Review of Work The majority of the post holders’ workload is referred by consultants and senior and junior doctors on a daily basis. The post holder conducts the workload autonomously within departmental protocols. Only if a complex non routine problem occurred would the post holder refer the matter to the senior chief of the department. Test required is clearly indicated on the referral slip, although the post holders has autonomy to review clinical details and expand information when appropriate and amend investigation as appropriate. Manipulate timings of investigation to accommodate additional investigation due to emerging clinical data. Apply time management skills to facilitate seamless patient pathway at one stop clinics Have a flexible way of working to dovetail additional assessments into finite time slots Post holder rotates through a range of diagnostic procedures in different Physiology specialities on a weekly/daily basis. Post holder undertakes these procedures in line with national , professional, hospital policies and guidelines. 9. Decisions and Judgements Analysing EGS and informing medical staff of significant/ life threatening changes Example: Recording an ECG with acute heart attack changes in A&E ensuring that medical staff are informed immediately to action thrombolytic therapy Analyse 24 hour recordings for significant abnormalities or life threatening arrhythmia and inform appropriate person with the correct degree of urgency Amending investigation in the light of emerging clinical data Example: Administering Bronchodilators /nebuliser during lung function test to relieve patients Symptoms / asses changes in clinical results due to drug therapy Example: Exercising a patient with normal arterial pressures to provoke symptoms to provide diagnosis Repeating Investigations due to equipment malfunction /electrode displacement Assess and analyse the functioning of complex equipment prior to proceeding with investigation. Example: recognition of spurious data and calibration drift which can cause inaccurate results Once recognised, post holder must re calibrate and repeat investigation. Compare patients results and interpret using respiratory knowledge to determine onward investigation pathway according to patients’ individual clinical status. Chooses appropriate pathway and interpret patient compliance, assesses level of compliance and interpret results accordingly to clinician. Take patient history, identify and categorise Doppler sound waves, measure arterial pressures, determine if normal or abnormal. Decide on next appropriate step , undertake further measurements and assessment. Record patient symptoms, walking distance and pain distance , record in medical case notes. 10. Most Challenging/Difficult Parts of the Job Working across physiological specialities. Maintaining skills and clinical knowledge across specialities. Communicating instructions effectively to patients to achieve the optimal results- this is also the most rewarding part of the work Managing workload to shifting and competing demands 11. Communications and Relationships The post holder communicates with patients throughout the working day. This may be to explain the procedure to be carried out, by talking the patient through the process, explaining in clear language what is to be information is to be gained from the procedure. Post holder encourages the patient to participate fully in the investigation to the best of their ability. Patients frequently require persuasion to continue with the investigation or require re assurance that they are acting appropriately. Patients are often unwilling/reluctant to undergo some investigative procedures, the post holder has to use good communication skills to establish a relationship of trust and empathy with the patient Post holder will deal with patients who have varying degrees of mental and or physical disability and use language that is appropriate to each patient. When dealing with children post holder must adapt language to explain the investigation , reassure patient and carer and encourage patient to be fully compliant The post holder communicates with a variety of health care professionals when arranging timings and conditions of the investigation Example: Arranging with ward staff to with hold bronchodilator for a set period prior to lung function test Post holder will communicate with colleagues throughout the day advising them of investigation results, informing them of any steps to be taken as an outcome of investigation results Post holder will explain to other medical/nursing staff investigation results, explain to medical staff results/procedure for training and education purposes. Contacting medical/nursing staff to clarify clinical information on patient referral. Communicating vital diagnostic information with the multi disciplinary team the a cardiac arrest Liasing with staff in other areas to arrange multi disciplinary sessions eg Cardioversion sessions in Day surgery 12. Physical, Mental, Emotional and Environmental Demands of the Job Physical skills /effort The post holder provides a service to many disparate areas within the organisation i.e. A&E Theatre reception and recovery, Endoscopy theatre, out-patient clinics, all wards both medical and surgical, secure psycho/care of the elderly wards, Post holder in carrying out duties will necessitate walking between the wards ,department, A&E and clinics. Running to cardiac arrests anywhere within the hospital Repetitive movements- inputting data via keyboard to clinical data bases , all equipment is now PC based.- 10 sessions Making fine movements with no margin for error Example: placing multiple electrodes within anatomically defined positions with no margin for error Pushing patients in wheel chairs, Pushing Cardiac machines around the hospital , working in confined ward areas. Manoeuvring of patients into position for investigation, many of whom have restricted mobility Mental Effort/skills Check that correct referral has been received and that procedure is carried out on correct patient Check that patient has followed advice on stopping drugs prior to procedure Maintaining high levels of concentration on large amounts of physiological data for prolonged periods. Example: Undertaking acute heart attack screening in acute medical wards, analysing each one for pathological changes from previous recording and alerting medical staff when appropriate Emotional effort/skills Dealing with traumatic situations Example: Cardiac Arrest in A&E or on treadmill Communicating with patients who have hereditary disease during screening process Working Conditions Post holder is exposed to bodily fluids Post holder will deal with patients who are MRSA +ve , HIV+ve, Hepatitis B&C+ve Post holder will working with patients with extensive leg ulcers which are malodorous Post holder will work with patients who may be abusive, aggressive, confused , agitated because of their medical condition. 13. Knowledge, Training and Experience Required to do the Job Entrance Level for trainee : 3 “A” Levels at Band D or 3 “H “ levels at Band C including Science subject(s) or equivalent pointage or an HNC in a Science subject. Academic and professional training in post will lead to: CARDIOLOGY Foundation degree or University Diploma in Clinical Physiology Associate Membership of the Society for Cardiological Science and Technology Knowledge and understanding of the affects of acquired or congenital disease on the diagnostic investigations undertaken within the department Specific knowledge and understanding of ECG interpretation and the effects of drugs and other therapies upon that interpretation. Trained to UK Resuscitation Council Immediate Life Support standard . Knowledge and understanding of the effects of co morbidity on investigations undertaken within the department RESPIRATORY Additional KTE is acquired through a combination of in house study days, Short courses arranged through the Association of Respiratory Technology and Physiology To include Master classes in Spirometry, Diffusion, Lung Volumes Interpretation and Quality Assurance Theoretical training and education equivalent to HNC level Knowledge and understanding of the effects of drugs on the Respiratory system Administration of therapeutic drugs to confirm diagnosis by analysis of changing lung volumes Knowledge and understanding of the effects of co morbidities (neuro muscular, ischaemic heart disease, surgery ) on investigation results Knowledge and understanding of complex gases and the administration thereof in the patient pathway. Competency in a range of complex respiratory investigations Ability to operate independently in the Acute or Primary care setting To undertake Community Spirometry clinics on a lone worker basis VASCULAR A combination of in house study days and short external courses through the Society for Vascular Technology leading accreditation Theoretical education and training in vascular anatomy and pathology Competent in a range of vascular investigations Operates independently within acute clinic and ward areas as part of the area vascular service Knowledge and understanding and implementation of appropriate aseptic techniques/ infection control GENERAL Knowledge understanding and training in Manual handling Knowledge and understanding of COSHH regulations Valid driving licence Person Specification Qualifications & Training – Essential Criteria Completed 1st and 2nd year of BSc in Clinical Physiology or equivalent Qualifications & Training – Desirable Criteria Computer literate Experience – Essential Criteria Working with people in a caring environment Experience – Desirable Criteria Team player Ability to work alone and prioritise workload Knowledge – Essential Criteria Understanding of the care environment Knowledge – Desirable Criteria Competencies & Skills – Essential Criteria Ability to work with health care professionals at all levels Good communication skills Excellent interpersonal and communication skills Competencies & Skills – Desirable Criteria Personal Characteristics and Other – Essential Criteria Driving licence Personal Characteristics and Other – Desirable Criteria