Download Operational definition of nursing

AGENDA FOR CHANGE
NHS JOB EVALUATION SCHEME
JOB DESCRIPTION TEMPLATE
Revised February 2010
1. JOB IDENTIFICATION
Job Title:
Community Staff Nurse/Clinic Nurse
Reports to:
Team Manager
Department, Ward or Section:
District Nursing Service West Team (Inverness and Beauly)
Operational Unit/Corporate Department: Inner Moray Firth Operational Unit, South & Mid
Job Code:
SMOUNESSCOMMNURS03
No of Job Holders:
35
Date:
January 2017
2. JOB PURPOSE
To contribute to the delivery of care to the total corporate and locality caseloads ensuring the delivery of
high standards of care to patients and their families in accordance to identified care plans.
3. DIMENSIONS
Based in the RNI and working within the District Nurse team to meet the community nursing care needs
of the local populations, there will be a focus on the delivery of care in a clinic setting for this post.
The District Nursing service is provided 7 days per week from 8.30am to 6pm in close collaboration with
General Practices, Community and Acute Hospitals, Social work services and voluntary agencies.
4. ORGANISATIONAL POSITION
Assistant
General Manager
Team Manager
Deputy Team Managers
Community Staff Nurse
Health Care Assistant
5. ROLE OF DEPARTMENT OR SECTION
The District Nursing service provides care to patients in their own homes and in the clinic setting who
are predominately older people with multiple pathology and complex health and social care needs
leading to chronic ill health, disability and dependence on carers, families, statutory and voluntary
services to remain in the community. The aim of the service is to manage health care in the community
to promote independence, prevent admission to hospital or facilitate hospital discharge. The service is
provided in conjunction with local hospitals, Raigmore District General, Primary Health Care Team and
Social Work Community Care Team and Home Care service. Patients access the level of care required
on a needs-led basis.
6. MAIN TASKS, DUTIES AND RESPONSIBILITIES
Operational definition of nursing
“The purpose of nursing and midwifery is to support each person to obtain, regain or maintain their
optimum state of health and independence within the scope of any physical, psychological or social
limitation, and to influence policies which affect health. This includes the use of nursing and midwifery
knowledge and skills to empower individuals and communities, by providing or enabling access to
appropriate care and support aimed at achieving the best attainable quality of life or a peaceful death”.
(Highland Primary Care NHS Trust 2002).
Professional nursing is practised within the concept of health and is grounded upon the World Health
Organisation’s definition of health which is: “a state of complete, physical, psychological and social wellbeing and not simply the absence of disease or infirmity” (WHO 1978).
1. Assist the Team Manager/Deputy or Senior Staff Nurse in corporate caseload management
(organising workload on geographical basis and nurse attachment to GP practices taking account of
individual’s workloads, skills requirements of patients, skills and learning needs of staff and frequency
of liaison with GP re. individual patients).
2. Assess the health and social care needs of patients and their carers analysing and synthesising
complex physiological measurements, emotional and psychosocial state and environmental settings
identifying deviations from normal. Make nursing diagnoses, plan, implement and evaluate nursing
interventions to meet needs agreed with patients and carers, with referral to other services as
required and reporting patient progress to caseload manager.
3. Assist patients, relatives and other formal and informal carers towards self-care and rehabilitation
through the provision of therapeutic, compensatory, educative, facilitative, rehabilitative, advocacy
and supportive clinical patient care.
4. Demonstrate clinical nursing skills and teach and assess students/observers during community
placements if required e.g. Student nurses, Return to Practice Nurses, Medical students and Medical
Registrar (nursing student placements are continuous).
5. Actively participate in implementation of clinical guidelines, best practice statement and relevant
audits of clinical practice to promote evidence based care and the attainment of healthcare
governance requirements.
6. Identify own education, training and support needs via the PDP and Review process and access
clinical supervision and, or action learning. Inform Team Leader of interim skills and knowledge
needs.
7. Practice within team administrative systems, national NHS, NHS Highland and NMC guidance.
8. Work collaboratively with the Team, Deputy Team Manager and Senior Staff Nurse in the day to day
operational management of the service including implementation of NHS Highland policies and
practices e.g., health and safety, infection control, PIN Guidelines and standing financial instructions.
9. Contribute to regular caseload profiling and community health needs assessment through the
collation of activity data, for the purpose of influencing health improvement priorities.
Dimensions (Clinical)
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Patients in the palliative stages of disease management or terminal phase of life requiring control
of symptoms (e.g. pain, nausea / vomiting, pressure area care, continence management),
assessment of need / and referral for other services (eg. Marie Curie nursing), provision of
nursing equipment (e.g. profiling bed, pressure relieving equipment), psychological and emotional
support to patient and family, health advice and education and follow-up bereavement support to
relatives.
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Teaching self-care procedures to enable patients and relatives to manage health needs (eg.
administration of medications, use of nebulisers, oxygen therapy, PEG feeding).
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Wound management - wound assessment, prescription and application of dressings and
associated health education, self-care and nutritional advice.
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Administration of prescribed medications, e.g. injections, enemata etc.
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Continence promotion – assessment of incontinence, promotion of continence and supply of
continence products.
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Chronic disease management (e.g. Coronary heart disease and Diabetes), screening and
monitoring re secondary prevention with the primary health care team.
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Long term management, rehabilitation and support of patients with chronic degenerative
conditions and disability that result in associated health problems, compromised mobility and
restricted ability to self care e.g.
- pressure area management and skin care,
- continence management including catheter care,
- provision of nursing equipment,
- on-going monitoring and assessment of health and care needs to remain safely at home with
referral for services i.e. home care, community alarm, meals at home, day care / respite
services, mobility aids and adaptations;
- health education and advice i.e. diet, exercise, self care, medication concordance, pain
control, etc.
- assisting patients/carers adapt to limitations imposed by health related problems including
emotional and psychological aspects of chronic ill health and dependency and anticipatory
guidance,
- prevention of complications of chronic ill health through early recognition of signs and
symptoms disease and health status monitoring – i.e. chronic disease management
screening, blood pressure recording, urinalysis, haematological assessment etc.
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Clinical procedures relevant to working within the Investigation and Treatment Clinic inc.
Venepuncture, ECGs, Picc line care and IV antibiotic therapy. This clinic will receive patient
referrals directly from Raigmore Hospital and will act as an interface between the acute and
primary care services within the Inner Moray Firth Unit.
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Training will be arranged as appropriate.
7. EQUIPMENT AND MACHINERY USED
1. General office equipment including computers – E-mail, NHS Highland Intranet and Internet, basic
word processing.
2. Assess patient’s needs for:
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minor aids and adaptations;
profiling beds;
electric air pressure relieving and overlay mattresses and cushions and supply appropriate
product as per Equipment Loan Store operational policy.
3. Provide mobile hoists
4. Basic car maintenance
5. Technical clinical equipment including calibrating where required, checking for faults and
ensuring regular maintenance as follows:
Equipment
Use
Syringe drivers
Ear syringes
Suction machines
Blood glucose monitors
Ultra sound “Doppler”
Hypodermic syringes and needles
Drug specific specialist needles and syringes
Venepuncture needles and blood collection tubes
ECG monitor
Percutaneous endospic gastrostomy (PEG)
feeding pump
Sharps containers
Anaphylaxis emergency equipment – face mask
and adrenaline for injection
Urinary catheters – urethral and suprapubic and
associated drainage equipment
Sphygmomanometers
Oxygen Cylinders and concentrators
Nebulisers
Suture/staple removal equipment
Subcutaneous drug administration
Removal of debris in ears
Removal of excess oral and airway secretions
Diabetic blood sugar control
Assessment of arterial blood supply in lower leg
Drug administration by injection
Drug administration
Collection of blood samples
Take readings for medical staff
Direct feeding into the stomach via fistula
Disposal of needles, syringes and drug vials
Resuscitation
Managing urinary incontinence
Blood pressure recording
To administer oxygen to patients in their home
Administration of medication via nebuliser
To remove sutures, staples and clips and for
suturing minor wounds
Pressure relieving equipment – mattresses and To prevent pressure Ulcers in patients.
cushions
Apnoea monitors
Alarms when patient has not breathed within a set
time. Used in patient with sleep apnoea
Thermometers
Temperature recording.
8. SYSTEMS
1. Maintain patient records in accordance with NMC guidelines and NHS Highland standards.
2. Complete and submit to Team Manager or deputy, end of month mileage returns & time sheets.
3. Complete Administrative Data System returns re patient visits, monthly.
4. Assist the Team Manager to monitor and revise caseload management.
9. ASSIGNMENT AND REVIEW OF WORK
1. Clinical workload is generated and prioritised via the nursing process (assessment, planning,
implementation and evaluation).
2. Professional development is reviewed via PDP process.
3. Accountable for own actions without direct supervision and care provided by unqualified staff.
10. DECISIONS AND JUDGEMENTS
1. Make autonomous clinical decisions using comprehensive knowledge, skills and experience of the
clinical service and setting taking account of the guidance of the professional body (Nursing and
Midwifery Council) and the employers’ policies and procedures informing Team Manager /
Deputy/Senior Staff Nurse of patient progress.
2. Make autonomous workload management decisions prioritising patient care and sharing of workload
with colleagues and delegation to nursing students and unqualified team members.
3. Recognise own limitations in the provision of clinical care and urgency of patient needs referring to
other health care professionals accordingly.
11. MOST CHALLENGING/DIFFICULT PARTS OF THE JOB
1. Involvement in change, service and practice
2. Negotiating packages of care with other disciplines / agencies who work within different cultures,
different response times and budgetary constraints.
3. Coping with potential and actual complex and or conflicting perspectives of choice of care options
between staff, patients, carers and other disciplines or agencies using negotiation and counselling
skills to achieve compromise and defuse possible volatile situations to achieve the best outcome for
the patient.
4. Stressful mental and physical demands of lone working in non NHS settings, for example patients
homes, where unpredictable behaviours, often associated with substance abuse are encountered
and un-hygienic environments or the presence of animals present increase personal risk and
challenges to the provision of professional standards of care.
5. Covering a large remote and rural geographical area. The roads are mainly single track/unclassified
with passing places that are winding, have steep gradients and blind summits.
6. Lone working when dealing with complex, sensitive and contentious situations.
7. Developing and learning new skills
12. COMMUNICATIONS AND RELATIONSHIPS
1. Establish and maintain professional relationships with nursing colleagues, members of the Primary
and Acute Health Care Team and wider health / social care / voluntary service networks to provide a
planned co-ordinated, seamless service for patients/clients.
2. Ensure the role and function of the service is known to all patients through verbal communication and
the provision of service information leaflets providing the opportunity to discuss care needs / care
provision and obtain feedback.
3. Maintaining effective communication and professional relationships with patients and their families,
especially within a small community setting.
4. Developing good observational skills and the ability to recognise verbal and non-verbal cues.
5. Early identification of potential and actual complex and or conflicting perspectives of choice of care
options between staff, patients, carers and other disciplines or agencies using negotiation and
counselling skills to achieve compromise and defuse possible volatile situations to achieve the best
outcome for the patient.
6. Observe confidentiality in accordance with NMC and NHS Highland polices.
13. PHYSICAL, MENTAL, EMOTIONAL AND ENVIRONMENTAL DEMANDS OF THE JOB
Physical Skills
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Fine motor skills and dexterity to take blood, administer injections, calibrate equipment – daily.
Physical Effort
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Regular effort to assist bed-bound patients to move position.
Bend and kneel to work with patients in cramped and restrictive environments, e.g. dress leg
wounds – daily
Driving long distances to visit patients particularly out with normal working hours and on single
track / unclassified roads.
Mental Effort
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Concentration, decision making and organisational skills to cope with competing demands,
(dynamic changes in patients conditions, personnel issues with staff, sudden staff absences,
unpredictable nature of referrals, contacts from within and out with the organisation – managers,
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other departments, other agencies) daily.
Recognising patients’ urgent health care needs and making rapid decisions to provide
appropriate clinical management - daily.
Ability to calculate drug dosages, daily.
Negotiation skills to co-ordinate complex packages of care with a wide range of people and
agencies as required.
Daily and continuous concentration to assess and provide patient care and assist in the
management of the corporate caseload with frequent interruptions either in person or by
telephone.
Concentration to drive in a busy urban environment during tourist season visiting patients homes
to deliver care – daily.
Emotional Effort
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Emotional demand in relation to family and human dynamics, coping with team members,
patients or carers in distress or crises such as dying and death, particularly following a long
period of care (weeks – months).
Emotional demands related to change - organisational, policy and practice - ongoing.
Risk-assess patient’s homes and be inventive to create a safe working environment whilst being
sensitive to patients environment and property - daily.
Environmental (Working Conditions)
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Coping with unpleasant materials and smells – bodily fluids, excreta, infected wounds – daily.
Exposure to aggressive, verbal and physical behaviour where there is little or no support.
Driving in extreme weather conditions in remote and untreated single track roads with additional
hazards of sheep, deer and other domestic animals.
Exposure to aggressive domestic/farm animals e.g. dogs - creating a safe entrance to the
patients home whilst keeping up relationships with patients and assessing risk.
Exposure to passive smoking.
Daily lone working in the community requiring self-reliance to continually assess risk to self, team
and patients.
14. KNOWLEDGE, TRAINING AND EXPERIENCE REQUIRED TO DO THE JOB
1. RGN. Registered with the NMC.
2. Knowledge of, and ability to, apply all relevant NHS Highland and professional policies, procedures
and guidelines.
3. Knowledge of processes involved in health and social policy development and of current policies and
their impact on district nursing services
4. Knowledge of the physical, social, emotional, psychological, mental, cultural effects of ageing,
disability, and chronic ill health, and, ability to assess an individual’s needs and behaviours and in
collaboration with a senior member of the team plan care within this broad context.
5. An understanding of clinical skills relevant to district nursing or working toward:
Holistic assessment of patients and carers needs.
- Chronic disease management at tertiary preventive and terminal stages specifically related to
diabetes, circulatory disease, major neurological conditions.
- Wound and skin care management and prevention of pressure ulcers.
- Management of elimination e.g., promotion of continence and management and symptom control
6.
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8.
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of incontinence – catheterisation: male, female and supra pubic, bowel care.
- Palliative/Terminal care including operation of syringe driver.
- Ultra sound “Doppler” assessment of arterial blood supply to lower limbs.
- Venepuncture.
- Ear syringing.
- Bladder scanner.
- ECGs.
- Teaching patients and carers to self care and provide anticipatory guidance re disease
progression, symptom management and consequences for lifestyle and quality of life.
- Teaching and assessing junior staff and students.
- Communication skills e.g. liaison, negotiation, and counselling skills.
- Health Promotion and Health Education.
A willingness to be involved in teaching, supervising, monitoring and supporting others in the
achievement of the above skills.
IT skills – e-mail, basic word processing, ability to search inter and intranet.
Good level of physical health and stamina, large and fine motor fitness and dexterity.
Car driver.
15. JOB DESCRIPTION AGREEMENT
I agree that the above Job Description is an accurate reflection of my duties and
responsibilities at the date of signing.
Job Holder’s Signature:
Date:
Manager’s Signature:
Date: